Provider Demographics
NPI:1922480441
Name:EXCELLENCE HOMECARE SUPPRT SERVICES , LLC.
Entity Type:Organization
Organization Name:EXCELLENCE HOMECARE SUPPRT SERVICES , LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BA
Authorized Official - Phone:267-536-8416
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-8274
Mailing Address - Country:US
Mailing Address - Phone:267-536-8416
Mailing Address - Fax:
Practice Address - Street 1:108 N HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2015
Practice Address - Country:US
Practice Address - Phone:267-536-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management