=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376715789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELLENT CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 07/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1840 W 49TH ST SUITE 402
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-398-3601
-----------------------------------------------------
Fax | 305-398-3604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1840 W 49TH ST SUITE 402
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-398-3601
-----------------------------------------------------
Fax | 305-398-3604
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ILEANA LLANOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-398-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299993021
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------