Healthcare Provider Details

I. General information

NPI: 1588961882
Provider Name (Legal Business Name): EXCEPTIONAL CARE WITHIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3494 HEATH DR
DELTONA FL
32725-3097
US

IV. Provider business mailing address

3494 HEATH DR
DELTONA FL
32725-3097
US

V. Phone/Fax

Practice location:
  • Phone: 407-520-1792
  • Fax: 386-218-4036
Mailing address:
  • Phone: 407-520-1792
  • Fax: 386-218-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. PAMELA YVONNE WRIGHT
Title or Position: OWNER
Credential:
Phone: 407-520-1792