Provider Demographics
NPI:1205162757
Name:EXCELLENT HOME HEALTH CARE
Entity type:Organization
Organization Name:EXCELLENT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BIVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-662-7993
Mailing Address - Street 1:181 E EVANS ST
Mailing Address - Street 2:C5
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2511
Mailing Address - Country:US
Mailing Address - Phone:843-662-7993
Mailing Address - Fax:843-662-7995
Practice Address - Street 1:612 STONEYBROOK TER
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8850
Practice Address - Country:US
Practice Address - Phone:843-662-7993
Practice Address - Fax:843-662-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEX0889251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEXO889Medicaid