Provider Demographics
NPI:1245501626
Name:EXCEPTIONAL TREATMENT HOME CARE INC
Entity type:Organization
Organization Name:EXCEPTIONAL TREATMENT HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-201-7390
Mailing Address - Street 1:1414 NW 107 AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:305-717-3130
Mailing Address - Fax:305-717-3130
Practice Address - Street 1:1414 NW 107 AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:305-717-3130
Practice Address - Fax:305-717-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health