MEDICARE: EXCELLENCE SAFE HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1740674274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE SAFE HOME CARE LLC

Provider Business Mailing Address
First Line	:	633 MAPLE CT
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2116
Country	:	US
Telephone Number	:	773-946-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 MAPLE CT
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-2116
Country	:	US
Telephone Number	:	773-946-0087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIZOR LEGE
Credential	:
Telephone Number	:	773-946-0087

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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