Provider Demographics
NPI:1760792568
Name:EXCEL HOME HEALTHCARE AGENCY & DME
Entity Type:Organization
Organization Name:EXCEL HOME HEALTHCARE AGENCY & DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOMODOU
Authorized Official - Middle Name:
Authorized Official - Last Name:JAITEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-601-6723
Mailing Address - Street 1:1100 LOGGER CT STE D100
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8509
Mailing Address - Country:US
Mailing Address - Phone:919-800-0221
Mailing Address - Fax:919-800-0221
Practice Address - Street 1:1100 LOGGER CT STE D100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-800-0221
Practice Address - Fax:919-800-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4250251E00000X
253Z00000X
NC136624332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies