Provider Demographics
NPI:1396502712
Name:EXTRA CARE PA PC
Entity type:Organization
Organization Name:EXTRA CARE PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:YAHAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-854-2544
Mailing Address - Street 1:1840 COUNTY LINE RD STE 100D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1718
Mailing Address - Country:US
Mailing Address - Phone:215-854-2544
Mailing Address - Fax:
Practice Address - Street 1:1840 COUNTY LINE RD STE 100D
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1718
Practice Address - Country:US
Practice Address - Phone:215-854-2544
Practice Address - Fax:215-475-5676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty