Provider Demographics
NPI:1760071096
Name:EXCLUSIVE ESTATES
Entity Type:Organization
Organization Name:EXCLUSIVE ESTATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUAVANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, NA, FIRST AID
Authorized Official - Phone:334-314-3868
Mailing Address - Street 1:1931 KINGSBURY DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3409
Mailing Address - Country:US
Mailing Address - Phone:334-314-3868
Mailing Address - Fax:334-398-8332
Practice Address - Street 1:1931 KINGSBURY DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3409
Practice Address - Country:US
Practice Address - Phone:334-314-3868
Practice Address - Fax:334-398-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL202100000202OtherOPEN