Healthcare Provider Details

I. General information

NPI: 1548768179
Provider Name (Legal Business Name): EXQUISITE HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 WINKLER AVE EXT APT 222
FORT MYERS FL
33916-9435
US

IV. Provider business mailing address

3625 WINKLER AVE EXT APT 222
FORT MYERS FL
33916-9435
US

V. Phone/Fax

Practice location:
  • Phone: 754-217-8193
  • Fax:
Mailing address:
  • Phone: 754-217-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DANIA DECADE
Title or Position: CEO
Credential:
Phone: 754-217-8193