Provider Demographics
NPI:1811233315
Name:XCELLENT HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:XCELLENT HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BHA, MHA
Authorized Official - Phone:912-272-4267
Mailing Address - Street 1:201 HARMONY BLVD APT 703
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-3652
Mailing Address - Country:US
Mailing Address - Phone:912-272-4267
Mailing Address - Fax:
Practice Address - Street 1:201 HARMONY BLVD APT 703
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-3652
Practice Address - Country:US
Practice Address - Phone:912-272-4267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
GALPNO64789251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251300000XAgenciesLocal Education Agency (LEA)