Provider Demographics
NPI:1457630907
Name:EXCELLENCE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:EXCELLENCE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAH-BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-755-6502
Mailing Address - Street 1:2238 S HAMILTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4382
Mailing Address - Country:US
Mailing Address - Phone:614-755-6502
Mailing Address - Fax:614-504-0042
Practice Address - Street 1:2238 S HAMILTON RD STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4382
Practice Address - Country:US
Practice Address - Phone:614-755-6502
Practice Address - Fax:614-504-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024397251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1457630907Medicaid