Provider Demographics
NPI:1316933658
Name:EXTENDI-CARE, INC.
Entity type:Organization
Organization Name:EXTENDI-CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-548-0190
Mailing Address - Street 1:824 SALEM RD
Mailing Address - Street 2:STE. 240
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4821
Mailing Address - Country:US
Mailing Address - Phone:501-548-0190
Mailing Address - Fax:501-327-5533
Practice Address - Street 1:824 SALEM RD
Practice Address - Street 2:STE. 240
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4821
Practice Address - Country:US
Practice Address - Phone:501-548-0190
Practice Address - Fax:501-327-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR005155332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0983000002Medicare NSC