MEDICARE: EXCELLENCE IN 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

General Provider Information

NPI Number	:	1760784946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE IN HOME CARE, INC.

Provider Business Mailing Address
First Line	:	8831 HAWBUCK ST
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5361
Country	:	US
Telephone Number	:	727-264-8853
Fax Number	:	727-264-8867

Provider Business Practice Location Address
First Line	:	8831 HAWBUCK ST
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-5361
Country	:	US
Telephone Number	:	727-264-8853
Fax Number	:	727-264-8867

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL JIMENEZ JR.
Credential	:
Telephone Number	:	813-264-6500

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	11/22/2010

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