Provider Demographics
NPI:1306879523
Name:EXTENDED HAND HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:EXTENDED HAND HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TORSHALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-972-9563
Mailing Address - Street 1:26311 RIDGEFIELD PARK LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4505
Mailing Address - Country:US
Mailing Address - Phone:281-972-9563
Mailing Address - Fax:713-583-7700
Practice Address - Street 1:26311 RIDGEFIELD PARK LN
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4505
Practice Address - Country:US
Practice Address - Phone:281-972-9563
Practice Address - Fax:713-583-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 251S00000X
TX009965251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216835301Medicaid