Provider Demographics
NPI:1871391565
Name:XTRA SPECIAL HOME CARE
Entity type:Organization
Organization Name:XTRA SPECIAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY CARE GIVER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-413-0043
Mailing Address - Street 1:16155 W 74TH DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7828
Mailing Address - Country:US
Mailing Address - Phone:303-912-1111
Mailing Address - Fax:
Practice Address - Street 1:3109 66TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8932
Practice Address - Country:US
Practice Address - Phone:314-413-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CY-LESS RANCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities