Provider Demographics
NPI:1467286831
Name:EXCEPTIONAL LIFE LLC
Entity type:Organization
Organization Name:EXCEPTIONAL LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMANDA
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-738-0320
Mailing Address - Street 1:2301 PAINTER LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7817
Mailing Address - Country:US
Mailing Address - Phone:407-738-0320
Mailing Address - Fax:
Practice Address - Street 1:2301 PAINTER LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7817
Practice Address - Country:US
Practice Address - Phone:407-738-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)