Healthcare Provider Details

I. General information

NPI: 1407117856
Provider Name (Legal Business Name): EXQUISITE SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 WASHINGTON ST
HOLLYWOOD FL
33020-5711
US

IV. Provider business mailing address

2616 WASHINGTON ST
HOLLYWOOD FL
33020-5711
US

V. Phone/Fax

Practice location:
  • Phone: 954-274-6849
  • Fax:
Mailing address:
  • Phone: 954-274-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number11251
License Number StateFL

VIII. Authorized Official

Name: AMY SMITH
Title or Position: OWNER
Credential:
Phone: 954-274-6849