Healthcare Provider Details

I. General information

NPI: 1699165134
Provider Name (Legal Business Name): EXCELLENT HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL DR. #400
MEMPHIS TN
38120
US

IV. Provider business mailing address

1661 INTERNATIONAL DR. #400
MEMPHIS TN
38120
US

V. Phone/Fax

Practice location:
  • Phone: 901-818-3078
  • Fax:
Mailing address:
  • Phone: 901-818-3078
  • 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 Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ELEXIS BRASWELL
Title or Position: OWNER
Credential:
Phone: 901-871-4010