Provider Demographics
NPI:1235403080
Name:EXCLUSIVE HOME CARE SERVICES
Entity Type:Organization
Organization Name:EXCLUSIVE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-806-0095
Mailing Address - Street 1:204 MOORE LN
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5039
Mailing Address - Country:US
Mailing Address - Phone:805-806-0095
Mailing Address - Fax:805-489-1399
Practice Address - Street 1:204 MOORE LN
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-5039
Practice Address - Country:US
Practice Address - Phone:805-806-0095
Practice Address - Fax:805-489-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623990324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility