Provider Demographics
NPI:1407153372
Name:EXCEPTIONAL HOME CARE LLC
Entity Type:Organization
Organization Name:EXCEPTIONAL HOME CARE LLC
Other - Org Name:HOMEWATCH CAREGIVERS OF ANN ARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BREANNE
Authorized Official - Middle Name:KINTE
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:734-622-8190
Mailing Address - Street 1:315 E EISENHOWER PKWY STE 9B
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3329
Mailing Address - Country:US
Mailing Address - Phone:734-622-8190
Mailing Address - Fax:734-864-7390
Practice Address - Street 1:315 E EISENHOWER PKWY STE 9B
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3329
Practice Address - Country:US
Practice Address - Phone:734-622-8190
Practice Address - Fax:734-864-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2280974251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2280974Medicaid