Provider Demographics
NPI:1386115608
Name:EXTENDED HEARTS HOME CARE, LLC
Entity type:Organization
Organization Name:EXTENDED HEARTS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAMEEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-722-9069
Mailing Address - Street 1:1100 LOGGER CT # G-103C
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8525
Mailing Address - Country:US
Mailing Address - Phone:919-722-9069
Mailing Address - Fax:
Practice Address - Street 1:1100 LOGGER CT # G-103C
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8525
Practice Address - Country:US
Practice Address - Phone:919-722-9069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTENDED HEARTS HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care