Provider Demographics
NPI:1568826626
Name:EXCELLENT LIVING MINISTRIES, INC
Entity Type:Organization
Organization Name:EXCELLENT LIVING MINISTRIES, INC
Other - Org Name:GRACE IN HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PASTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-867-1233
Mailing Address - Street 1:3690 PERSHALL RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-1410
Mailing Address - Country:US
Mailing Address - Phone:314-867-1233
Mailing Address - Fax:314-867-6554
Practice Address - Street 1:3690 PERSHALL RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1410
Practice Address - Country:US
Practice Address - Phone:314-867-1233
Practice Address - Fax:314-867-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health