MEDICARE: LITTLE EXCELLENCE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1518789890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE EXCELLENCE LLC

Provider Business Mailing Address
First Line	:	2144 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-370-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	2144 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3916
Country	:	US
Telephone Number	:	718-370-3784
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DEBRA MACKEY
Credential	:
Telephone Number	:	848-222-4852

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	01/28/2026

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Directions to “LITTLE EXCELLENCE LLC ” Practice Location

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