Provider Demographics
NPI:1588630081
Name:EXCELL HOME CARE, INC.
Entity Type:Organization
Organization Name:EXCELL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:O
Authorized Official - Last Name:TY-DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP
Authorized Official - Phone:562-988-3370
Mailing Address - Street 1:4014 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5413
Mailing Address - Country:US
Mailing Address - Phone:562-988-3370
Mailing Address - Fax:562-988-3373
Practice Address - Street 1:4014 LONG BEACH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5413
Practice Address - Country:US
Practice Address - Phone:562-988-3370
Practice Address - Fax:562-988-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08212FMedicaid
CA058212Medicare ID - Type Unspecified