Provider Demographics
NPI:1326857210
Name:XTRAORDINARY HEALTH HOME CARE LLC
Entity type:Organization
Organization Name:XTRAORDINARY HEALTH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUA
Authorized Official - Middle Name:SHA'NA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:989-280-6815
Mailing Address - Street 1:3521 STATE ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3521 STATE ST UNIT 4
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3267
Practice Address - Country:US
Practice Address - Phone:989-280-6815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health