Provider Demographics
NPI:1588487326
Name:EXALT HEALTH CARE LLC
Entity type:Organization
Organization Name:EXALT HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGOE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-276-4141
Mailing Address - Street 1:567 COASTAL AVE
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-6857
Mailing Address - Country:US
Mailing Address - Phone:571-276-4141
Mailing Address - Fax:
Practice Address - Street 1:5290 SHAWNEE RD STE 200
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2381
Practice Address - Country:US
Practice Address - Phone:571-276-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health