Healthcare Provider Details

I. General information

NPI: 1821734724
Provider Name (Legal Business Name): EXUBERANT HOME CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WELTON ST APT 1519
DENVER CO
80205-4074
US

IV. Provider business mailing address

2100 WELTON ST APT 1519
DENVER CO
80205-4074
US

V. Phone/Fax

Practice location:
  • Phone: 303-416-7155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY SEPH IVEY
Title or Position: OWNER
Credential:
Phone: 303-835-3429