MEDICARE: EXCELSIOR HEALTHCARE, INC.

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	372500000X	Chore Provider

General Provider Information

NPI Number	:	1760310866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELSIOR HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	5359 BIRCH GROVE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1707
Country	:	US
Telephone Number	:	408-614-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	5359 BIRCH GROVE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1707
Country	:	US
Telephone Number	:	408-614-6649
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BERNELLET TAA
Credential	:	EXCELSIOR HEALTHCARE
Telephone Number	:	408-614-6649

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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