Provider Demographics
NPI:1467328062
Name:EXTENDED ARMS RESPITE GROUP
Entity type:Organization
Organization Name:EXTENDED ARMS RESPITE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-908-1511
Mailing Address - Street 1:636 GAUSE BLVD STE 304
Mailing Address - Street 2:#173
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2007
Mailing Address - Country:US
Mailing Address - Phone:504-490-4055
Mailing Address - Fax:
Practice Address - Street 1:251 ASHTON PARC
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-7321
Practice Address - Country:US
Practice Address - Phone:504-490-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385H00000XRespite Care FacilityRespite Care