Provider Demographics
NPI:1700436813
Name:EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Entity Type:Organization
Organization Name:EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Other - Org Name:EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:INNOCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPUAKA
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE, BS
Authorized Official - Phone:410-304-6544
Mailing Address - Street 1:PO BOX 31699
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-8699
Mailing Address - Country:US
Mailing Address - Phone:410-984-7411
Mailing Address - Fax:410-645-8828
Practice Address - Street 1:4002 W BELVEDERE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5502
Practice Address - Country:US
Practice Address - Phone:410-984-7411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit