Provider Demographics
NPI:1598222820
Name:EXCEPTIONAL CARE LIVING, INC
Entity Type:Organization
Organization Name:EXCEPTIONAL CARE LIVING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:FAYTHE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-686-2994
Mailing Address - Street 1:10 SERPENS CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2323
Mailing Address - Country:US
Mailing Address - Phone:443-686-2994
Mailing Address - Fax:
Practice Address - Street 1:1806 EDMONDSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1225
Practice Address - Country:US
Practice Address - Phone:443-686-2994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251B00000XAgenciesCase Management