Healthcare Provider Details

I. General information

NPI: 1982317467
Provider Name (Legal Business Name): IMMACULATE ESSENTIAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HADDONFIELD RD STE 204
CHERRY HILL NJ
08002-1467
US

IV. Provider business mailing address

4 HADDONFIELD RD STE 204
CHERRY HILL NJ
08002-1467
US

V. Phone/Fax

Practice location:
  • Phone: 856-524-3140
  • Fax: 855-674-1833
Mailing address:
  • Phone: 856-524-3140
  • Fax: 855-674-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK POLLEY
Title or Position: MANAGING PARTNER
Credential:
Phone: 856-524-3140