Provider Demographics
NPI:1619339892
Name:EXCELLENCE HOME SUPPORT
Entity Type:Organization
Organization Name:EXCELLENCE HOME SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-303-2544
Mailing Address - Street 1:12855 SW 136TH AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5885
Mailing Address - Country:US
Mailing Address - Phone:786-406-4224
Mailing Address - Fax:
Practice Address - Street 1:12855 SW 136TH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5885
Practice Address - Country:US
Practice Address - Phone:786-406-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care