Provider Demographics
NPI:1235474099
Name:EXCELLENT CARE INCORPORATED
Entity Type:Organization
Organization Name:EXCELLENT CARE INCORPORATED
Other - Org Name:LOVING CARE INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-865-8085
Mailing Address - Street 1:PO BOX 823038
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-3038
Mailing Address - Country:US
Mailing Address - Phone:954-865-8085
Mailing Address - Fax:
Practice Address - Street 1:1801 NW 134TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33167-1545
Practice Address - Country:US
Practice Address - Phone:305-687-1853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320600000X, 320700000X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687611196Medicaid
FL687611198Medicaid