MEDICARE: EXCEL CONSULTING AND MANAGEMENT GROUP

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1891102398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL CONSULTING AND MANAGEMENT GROUP

Provider Business Mailing Address
First Line	:	4080 E LAKE MEAD BLVD
Second Line	:	SUITE C-102
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6466
Country	:	US
Telephone Number	:	702-612-8473
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 E LAKE MEAD BLVD
Second Line	:	SUITE C-102
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6466
Country	:	US
Telephone Number	:	702-612-8473
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ANITA COLLINS
Credential	:
Telephone Number	:	702-612-8473

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/16/2014

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