MEDICARE: EXCLUSIVE HOME CARE AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1558937300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCLUSIVE HOME CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	7101 WILSON BLVD APT 4302
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3697
Country	:	US
Telephone Number	:	386-983-5819
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 WILSON BLVD APT 4302
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-3697
Country	:	US
Telephone Number	:	386-983-5819
Fax Number	:

Authorized Official
Title or Position	:	CFO /OWNER
Name	:	CARLEEN SCHWARZ
Credential	:
Telephone Number	:	386-983-5819

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/03/2021

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