Provider Demographics
NPI:1548516297
Name:EXTOL HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:EXTOL HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:OBIAGELI
Authorized Official - Last Name:UME-EZEOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-528-0849
Mailing Address - Street 1:6120 COBBLE TRL
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3829
Mailing Address - Country:US
Mailing Address - Phone:469-528-0849
Mailing Address - Fax:
Practice Address - Street 1:6120 COBBLE TRL
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3829
Practice Address - Country:US
Practice Address - Phone:469-528-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health