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General NPI Number Information
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NPI Number | 1912591298
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Entity Type | Organization
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Legal Business Name | EXCELSIOR HHA
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Dates
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Enumeration Date | 02/26/2021
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 1320 SW 82ND TER APT 422
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City | PLANTATION
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State | FL
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Zip | 33324-3221
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Country | US
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Telephone | 954-399-1391
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Fax |
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Provider Business Mailing Address
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Address Line | 7750 OKEECHOBEE BLVD STE 4
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | HOME HEALTH AIDE
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Name | SHARNIECE JAMISON
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Credential |
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Telephone | 954-399-1391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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