Provider Demographics
NPI:1043880016
Name:EXCELLENCE HOME CARE
Entity Type:Organization
Organization Name:EXCELLENCE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASTGHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGHATELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-786-7379
Mailing Address - Street 1:620 CRAGIN PARK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 CRAGIN PARK DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4313
Practice Address - Country:US
Practice Address - Phone:702-786-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty