Provider Demographics
NPI:1184708141
Name:EXCEL HOME CARE, INC.
Entity type:Organization
Organization Name:EXCEL HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:EYDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-991-3689
Mailing Address - Street 1:10845 OLIVE BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7760
Mailing Address - Country:US
Mailing Address - Phone:314-991-3689
Mailing Address - Fax:314-991-3750
Practice Address - Street 1:10845 OLIVE BLVD STE 165
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7760
Practice Address - Country:US
Practice Address - Phone:314-991-3689
Practice Address - Fax:314-991-3750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCEL HOME CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO265173302251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265173302Medicaid