Provider Demographics
NPI:1942957873
Name:EXALTED LIFE HOME CARE LLC
Entity Type:Organization
Organization Name:EXALTED LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-721-7801
Mailing Address - Street 1:317 E SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-2318
Mailing Address - Country:US
Mailing Address - Phone:267-721-7801
Mailing Address - Fax:
Practice Address - Street 1:317 E SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-2318
Practice Address - Country:US
Practice Address - Phone:267-721-7801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7439862OtherDEPT OF STATE BUREAU OF CORPORATIONS AND CHARITABLE ORG.