Provider Demographics
NPI:1588115521
Name:EXALTED HOME CARE LLC
Entity type:Organization
Organization Name:EXALTED HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-7062
Mailing Address - Street 1:440 N 18TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2255
Mailing Address - Country:US
Mailing Address - Phone:409-838-4049
Mailing Address - Fax:409-838-4608
Practice Address - Street 1:440 N 18TH ST STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2255
Practice Address - Country:US
Practice Address - Phone:409-838-4049
Practice Address - Fax:409-838-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009764251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677802OtherMEDICARE PROVIDER NUMBER
677802Medicare PIN