Provider Demographics
NPI:1649767393
Name:EXCEPTIONAL HOME CARE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:EXCEPTIONAL HOME CARE OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-310-5055
Mailing Address - Street 1:2475 MERCER AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-7452
Mailing Address - Country:US
Mailing Address - Phone:561-310-5055
Mailing Address - Fax:561-516-7343
Practice Address - Street 1:2475 MERCER AVE STE 302
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7452
Practice Address - Country:US
Practice Address - Phone:561-310-5055
Practice Address - Fax:561-516-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1649767393Medicaid