Provider Demographics
NPI:1497283238
Name:EXCELLENCE HOME CARE LLC
Entity Type:Organization
Organization Name:EXCELLENCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MINTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-399-9896
Mailing Address - Street 1:324 BELLONA LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6210
Mailing Address - Country:US
Mailing Address - Phone:864-399-9896
Mailing Address - Fax:
Practice Address - Street 1:117 FAIRVIEW POINTE DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3223
Practice Address - Country:US
Practice Address - Phone:864-399-9896
Practice Address - Fax:864-399-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0711253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care