MEDICARE: EXCELLENCE HOME CARE NURSE REGISTRY, 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
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932861697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCELLENCE HOME CARE NURSE REGISTRY, LLC.

Provider Business Mailing Address
First Line	:	12995 S CLEVELAND AVE STE 52
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7752
Country	:	US
Telephone Number	:	239-710-0150
Fax Number	:	239-790-1328

Provider Business Practice Location Address
First Line	:	12995 S CLEVELAND AVE STE 52
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7752
Country	:	US
Telephone Number	:	239-710-0150
Fax Number	:	239-790-1328

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIVIAM MATURELL
Credential	:
Telephone Number	:	239-710-0150

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	05/11/2022

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