Provider Demographics
NPI:1942420542
Name:EXCEL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:EXCEL HEALTHCARE, INC.
Other - Org Name:WEST COVINA ADULT DAY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-918-9887
Mailing Address - Street 1:1633 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1137
Mailing Address - Country:US
Mailing Address - Phone:626-918-9887
Mailing Address - Fax:626-918-6647
Practice Address - Street 1:1633 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1137
Practice Address - Country:US
Practice Address - Phone:626-918-9887
Practice Address - Fax:626-918-6647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000795261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMCSUBHVYOtherCMC SUBMISSION ID
CAADU70285FMedicaid