Provider Demographics
NPI:1356885495
Name:EXCELLENCE HOME SUPPORT. CORP
Entity type:Organization
Organization Name:EXCELLENCE HOME SUPPORT. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERNANDEZ PADIN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE REGISTRY
Authorized Official - Phone:786-701-3225
Mailing Address - Street 1:12855 SW 136 AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:786-701-3225
Mailing Address - Fax:855-474-0933
Practice Address - Street 1:12855 SW 136 AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-701-3225
Practice Address - Fax:855-474-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211880OtherNURSE REGISTRY