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General NPI Number Information
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NPI Number | 1427384783
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Entity Type | Organization
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Legal Business Name | EXELLE HOME CARE
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Dates
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Enumeration Date | 10/21/2009
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 105 SILVERTHORN DRIVE
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City | TYRONE
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State | GA
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Zip | 30290
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Country | US
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Telephone | 678-670-7569
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Fax | 770-703-7862
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Provider Business Mailing Address
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Address Line | P.O. BOX 394
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City | TYRONE
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State | GA
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Zip | 30290
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Country | US
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Telephone | 678-670-7569
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Fax | 770-703-7862
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DESMOND THORPE
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Credential |
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Telephone | 678-670-7569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 060R0163
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 060R0163
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License Number State | GA
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