Healthcare Provider Details

I. General information

NPI: 1922480441
Provider Name (Legal Business Name): EXCELLENCE HOMECARE SUPPRT SERVICES , LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2015
Last Update Date: 06/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N HIGHLAND AVE SUITE 2
LANSDOWNE PA
19050-2015
US

IV. Provider business mailing address

PO BOX 1274
LANSDOWNE PA
19050-8274
US

V. Phone/Fax

Practice location:
  • Phone: 267-536-8416
  • Fax:
Mailing address:
  • Phone: 267-536-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FATIMA K WOODARD
Title or Position: CEO
Credential: LPN, BA
Phone: 267-536-8416