Provider Demographics
NPI:1437773942
Name:EXCELLENT CARE LLC
Entity Type:Organization
Organization Name:EXCELLENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAMECK
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAKWEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-430-9646
Mailing Address - Street 1:14029 N 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-5438
Mailing Address - Country:US
Mailing Address - Phone:602-430-9646
Mailing Address - Fax:
Practice Address - Street 1:14029 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5438
Practice Address - Country:US
Practice Address - Phone:602-430-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility