Provider Demographics
NPI:1972151082
Name:EXCELLENT SUPPORT SERVICES
Entity Type:Organization
Organization Name:EXCELLENT SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:
Authorized Official - First Name:KOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-259-8962
Mailing Address - Street 1:1801 S 58TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-5501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 S 58TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-5501
Practice Address - Country:US
Practice Address - Phone:267-259-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-01
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care