Provider Demographics
NPI:1396317632
Name:EXTRAORDINARY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:EXTRAORDINARY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:781-831-1760
Mailing Address - Street 1:16 BARTLETT LN
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 BARTLETT LN
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-1202
Practice Address - Country:US
Practice Address - Phone:781-831-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health