Provider Demographics
NPI:1518202142
Name:EXCELSIS HOME HEALTH CARE,INC
Entity Type:Organization
Organization Name:EXCELSIS HOME HEALTH CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-322-0400
Mailing Address - Street 1:13 W US HIGHWAY 30
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2266
Mailing Address - Country:US
Mailing Address - Phone:219-322-0400
Mailing Address - Fax:219-322-0420
Practice Address - Street 1:13 W US HIGHWAY 30
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2266
Practice Address - Country:US
Practice Address - Phone:219-322-0400
Practice Address - Fax:219-322-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-08
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health