Provider Demographics
NPI:1427699743
Name:EXTRACARE HOMECARE SERVICES
Entity type:Organization
Organization Name:EXTRACARE HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OSINAKACHI
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-455-9577
Mailing Address - Street 1:670 CHURCH LN
Mailing Address - Street 2:2ND FLOOR FRONT
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3301
Mailing Address - Country:US
Mailing Address - Phone:267-455-9577
Mailing Address - Fax:484-540-7913
Practice Address - Street 1:670 CHURCH LN
Practice Address - Street 2:2ND FLOOR FRONT
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3301
Practice Address - Country:US
Practice Address - Phone:267-455-9577
Practice Address - Fax:484-540-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA42373601OtherPROVIDER LICENSE NUMBER