MEDICARE: EXCELL HOME CARE, INC.

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	251E00000X	Home Health Agency		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588630081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELL HOME CARE, INC.

Provider Business Mailing Address
First Line	:	4014 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5413
Country	:	US
Telephone Number	:	562-988-3370
Fax Number	:	562-988-3373

Provider Business Practice Location Address
First Line	:	4014 LONG BEACH BLVD
Second Line	:	SUITE 300
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5413
Country	:	US
Telephone Number	:	562-988-3370
Fax Number	:	562-988-3373

Authorized Official
Title or Position	:	CEO
Name	:	MRS. JENNIFER O. TY-DE GUZMAN
Credential	:	MSN, FNP
Telephone Number	:	562-988-3370

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	08/22/2020

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