| Extended Family Care Llc | |
|
30 Powers Bridge Rd Manchester TN 37355-2806 | |
| (931) 954-5225 | |
| (931) 954-5221 |
| Full Name | Extended Family Care Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 30 Powers Bridge Rd, Manchester, Tennessee |
| Authorized Official Name and Position | Rose Lonnette Dodge (ADMINISTRATOR / OWNER) |
| Authorized Official Contact | 9319523499 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Extended Family Care Llc 30 Powers Bridge Rd Manchester TN 37355-2806 Ph: (931) 954-5225 | Extended Family Care Llc 30 Powers Bridge Rd Manchester TN 37355-2806 Ph: (931) 954-5225 |
| NPI Number | 1700172392 |
|---|---|
| Provider Enumeration Date | 06/22/2011 |
| Last Update Date | 10/23/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700172392 | NPI | - | NPPES |
| H445690 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | I000000017110 (Tennessee) | Primary |
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