Healthcare Provider Details

I. General information

NPI: 1033930581
Provider Name (Legal Business Name): EXCELLENT LIFE HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5539 LAUREL HALL DR
INDIANAPOLIS IN
46226-2302
US

IV. Provider business mailing address

260 RIDGE POINTE DR
COVINGTON GA
30016-4744
US

V. Phone/Fax

Practice location:
  • Phone: 317-812-7797
  • Fax:
Mailing address:
  • Phone: 678-794-2673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: LACHELLE DENISE WILLIAMS
Title or Position: OWNER
Credential: LPN
Phone: 678-794-2637