Provider Demographics
NPI:1669617288
Name:EXCELLENT HEALTHCARE SERVICES,INC
Entity type:Organization
Organization Name:EXCELLENT HEALTHCARE SERVICES,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-962-0290
Mailing Address - Street 1:PO BOX 1122
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76004-1122
Mailing Address - Country:US
Mailing Address - Phone:817-962-0290
Mailing Address - Fax:817-962-0292
Practice Address - Street 1:1144 W PIONEER PKWY STE H1144
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6389
Practice Address - Country:US
Practice Address - Phone:817-962-0290
Practice Address - Fax:817-962-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2826430Medicaid