Provider Demographics
NPI:1619315694
Name:EXCELSIOR PRIVATE HOME CARE LLC
Entity Type:Organization
Organization Name:EXCELSIOR PRIVATE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILIETH
Authorized Official - Middle Name:VERINICA
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-655-8360
Mailing Address - Street 1:270 TRELAWNEY DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6819
Mailing Address - Country:US
Mailing Address - Phone:770-385-8194
Mailing Address - Fax:
Practice Address - Street 1:270 TRELAWNEY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6819
Practice Address - Country:US
Practice Address - Phone:770-385-8194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health