Healthcare Provider Details

I. General information

NPI: 1972541449
Provider Name (Legal Business Name): EXCEL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4170 LAFAYETTE CENTER DR SUITE 300
CHANTILLY VA
20151-1254
US

IV. Provider business mailing address

1910 PAYSPHERE CIR
CHICAGO IL
60674-0019
US

V. Phone/Fax

Practice location:
  • Phone: 703-471-8200
  • Fax: 703-471-8205
Mailing address:
  • Phone: 800-879-6137
  • Fax: 847-913-9024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number0201003388
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0201003388
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number0201003388
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number0201003388
License Number StateVA

VIII. Authorized Official

Name: JOSEPH BONACCORSI
Title or Position: SR VP, SECRETARY & GENERAL COUNSEL
Credential: JD
Phone: 847-229-7794