Healthcare Provider Details

I. General information

NPI: 1235474099
Provider Name (Legal Business Name): EXCELLENT CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW 134TH ST
MIAMI FL
33167-1545
US

IV. Provider business mailing address

PO BOX 823038
PEMBROKE PINES FL
33082-3038
US

V. Phone/Fax

Practice location:
  • Phone: 305-687-1853
  • Fax:
Mailing address:
  • Phone: 954-865-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. PATRICK BLANC
Title or Position: PRESIDENT
Credential:
Phone: 305-865-8085