Provider Demographics
NPI:1801198783
Name:EXCELLENT HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:EXCELLENT HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULEKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-805-1767
Mailing Address - Street 1:1337 TRAILWAY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-2982
Mailing Address - Country:US
Mailing Address - Phone:614-805-1767
Mailing Address - Fax:
Practice Address - Street 1:1337 TRAILWAY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-2982
Practice Address - Country:US
Practice Address - Phone:614-805-1767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-25
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health