Provider Demographics
NPI:1083134738
Name:EXTRA HAND IN-HOME CARE, LLC
Entity type:Organization
Organization Name:EXTRA HAND IN-HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-360-2223
Mailing Address - Street 1:8439 WHITE OAK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3860
Mailing Address - Country:US
Mailing Address - Phone:909-360-2223
Mailing Address - Fax:909-360-2293
Practice Address - Street 1:8439 WHITE OAK AVE STE 104
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3860
Practice Address - Country:US
Practice Address - Phone:909-360-2223
Practice Address - Fax:909-360-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 251J00000X, 372600000X, 374U00000X, 376J00000X, 376K00000X, 385HR2050X
CA364700044253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No385HR2050XRespite Care FacilityRespite CareRespite Care CampGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080126397OtherDUN & BRADSTREET
CA364700044OtherCALIFORNIA DEPTARTMENT OF SOCIAL SERVICES
CA550007839OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH