Provider Demographics
NPI:1568820603
Name:EXCELLENT CARE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:EXCELLENT CARE HOME HEALTH SERVICES LLC
Other - Org Name:DESTINY HOME HEALTH SERVICES LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:AKHOASEGBE
Authorized Official - Last Name:EHICHIOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHMNP, PHD
Authorized Official - Phone:703-973-0176
Mailing Address - Street 1:1684 ROSEDALE CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3014
Mailing Address - Country:US
Mailing Address - Phone:703-973-0176
Mailing Address - Fax:571-428-2027
Practice Address - Street 1:1684 ROSEDALE CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3014
Practice Address - Country:US
Practice Address - Phone:571-359-6335
Practice Address - Fax:571-428-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161374251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568820603Medicaid