Healthcare Provider Details

I. General information

NPI: 1467763854
Provider Name (Legal Business Name): EXQUISITE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5640 READ BLVD STE 220
NEW ORLEANS LA
70127-7805
US

IV. Provider business mailing address

2312 N HARPER DR
HARVEY LA
70058-1334
US

V. Phone/Fax

Practice location:
  • Phone: 504-244-0455
  • Fax:
Mailing address:
  • Phone: 504-251-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number40178639K
License Number StateLA

VIII. Authorized Official

Name: MS. BRANDI GRAY
Title or Position: NURE PRACTITIONER
Credential:
Phone: 504-251-0493