MEDICARE: EXCEL EXTENDED CARE ORGANIZATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1386500361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL EXTENDED CARE ORGANIZATION

Provider Business Mailing Address
First Line	:	3110 POLARIS AVE STE 23
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8359
Country	:	US
Telephone Number	:	725-253-7257
Fax Number	:	702-359-0041

Provider Business Practice Location Address
First Line	:	3110 POLARIS AVE STE 23
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-8359
Country	:	US
Telephone Number	:	725-253-7257
Fax Number	:	702-359-0041

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	EBONY AKEEYA DANFORD
Credential	:
Telephone Number	:	725-253-7257

Provider Enumeration Date	:	01/02/2026
Last Update Date	:	01/02/2026

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