=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225845803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXECUTIVE HOME SERIVCES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2024
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 894 MACCLESFIELD RD
-----------------------------------------------------
City | FURLONG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18925-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-276-1978
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 894 MACCLESFIELD RD
-----------------------------------------------------
City | FURLONG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18925-1411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-276-1978
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTOPHER TODD SLACK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-276-1978
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------