Provider Demographics
NPI:1508377466
Name:EXCELL ADULT DAY CARE CENTER INCORPORATION
Entity Type:Organization
Organization Name:EXCELL ADULT DAY CARE CENTER INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN-HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-453-7756
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1444
Mailing Address - Country:US
Mailing Address - Phone:706-453-7756
Mailing Address - Fax:
Practice Address - Street 1:504 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1458
Practice Address - Country:US
Practice Address - Phone:706-453-7756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000048261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003115207BMedicaid