Provider Demographics
NPI:1023134491
Name:EXTRA HANDS INCORPORATED
Entity type:Organization
Organization Name:EXTRA HANDS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-334-5333
Mailing Address - Street 1:937 BROADWAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-5474
Mailing Address - Country:US
Mailing Address - Phone:573-334-5333
Mailing Address - Fax:573-334-4031
Practice Address - Street 1:937 BROADWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5474
Practice Address - Country:US
Practice Address - Phone:573-334-5333
Practice Address - Fax:573-334-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODA8020376J00000X
MO3176 7622320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265249904OtherDOA
MO855249900Medicaid
MO285249900OtherDOA