Provider Demographics
NPI:1447935242
Name:IMMACULATE ESSENTIAL CARE, LLC
Entity type:Organization
Organization Name:IMMACULATE ESSENTIAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-524-3140
Mailing Address - Street 1:2995 CHAPEL AVE W APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3911
Mailing Address - Country:US
Mailing Address - Phone:856-524-3140
Mailing Address - Fax:
Practice Address - Street 1:4 HADDONFIELD RD STE 204
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1467
Practice Address - Country:US
Practice Address - Phone:856-524-3140
Practice Address - Fax:855-674-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child