Healthcare Provider Details

I. General information

NPI: 1285210294
Provider Name (Legal Business Name): XCEPTIONAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28925 GLENWOOD ST
INKSTER MI
48141
US

IV. Provider business mailing address

28925 GLENWOOD ST
INKSTER MI
48141-1625
US

V. Phone/Fax

Practice location:
  • Phone: 313-461-8691
  • Fax:
Mailing address:
  • Phone: 313-461-8691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAVONA WISE
Title or Position: ADMINISTRATOR
Credential:
Phone: 313-461-8691