Provider Demographics
NPI:1437665619
Name:IMPECCABLE SENIORS CARE LLC
Entity Type:Organization
Organization Name:IMPECCABLE SENIORS CARE LLC
Other - Org Name:IMPECCABLE SENIORS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-704-8212
Mailing Address - Street 1:5578 N ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-1033
Mailing Address - Country:US
Mailing Address - Phone:407-704-8212
Mailing Address - Fax:407-704-5010
Practice Address - Street 1:5578 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-1033
Practice Address - Country:US
Practice Address - Phone:407-704-8212
Practice Address - Fax:407-704-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-25
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTIN