MEDICARE: EXCEPTIONAL HEALTHCARE SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261Q00000X	Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508466533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEPTIONAL HEALTHCARE SERVICES CORP

Provider Business Mailing Address
First Line	:	4318 SW 9TH PL
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-5759
Country	:	US
Telephone Number	:	239-645-2730
Fax Number	:

Provider Business Practice Location Address
First Line	:	13240 N CLEVELAND AVE STE 1
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-4855
Country	:	US
Telephone Number	:	239-645-2730
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OSBEL VARGAS GONZALEZ
Credential	:	RN
Telephone Number	:	239-645-2730

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	11/09/2020

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Directions to “EXCEPTIONAL HEALTHCARE SERVICES CORP ” Practice Location

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