MEDICARE: EXCELSIOR HEALTHCARE LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1861944670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELSIOR HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	2611 N 14TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3914
Country	:	US
Telephone Number	:	314-899-9950
Fax Number	:	314-899-9949

Provider Business Practice Location Address
First Line	:	2611 N 14TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-3914
Country	:	US
Telephone Number	:	314-899-9950
Fax Number	:	314-899-9949

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL Q BOYD
Credential	:
Telephone Number	:	314-749-2535

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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