Provider Demographics
NPI:1962728071
Name:EXTRAORDINARY HOME CARE
Entity type:Organization
Organization Name:EXTRAORDINARY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FREDERIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-281-8688
Mailing Address - Street 1:333 EARLE OVINGTON BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3622
Mailing Address - Country:US
Mailing Address - Phone:718-281-8600
Mailing Address - Fax:
Practice Address - Street 1:333 EARLE OVINGTON BLVD STE 600
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3622
Practice Address - Country:US
Practice Address - Phone:718-281-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY337438Medicare Oscar/Certification