=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689718793
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCEL HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 S 5TH ST STE 100
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-896-0505
-----------------------------------------------------
Fax | 636-724-4244
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1360 S 5TH ST STE 100
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-896-0505
-----------------------------------------------------
Fax | 636-724-4244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | BRENDA RICHTER
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 636-896-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0007683
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------