Provider Demographics
NPI:1801249578
Name:EXCELSIOR HOME CARE
Entity type:Organization
Organization Name:EXCELSIOR HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLUCHI
Authorized Official - Middle Name:N
Authorized Official - Last Name:UGAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-413-6893
Mailing Address - Street 1:1458 HANCOCK ST STE 228
Mailing Address - Street 2:P.O,BOX 2500
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5214
Mailing Address - Country:US
Mailing Address - Phone:857-413-6893
Mailing Address - Fax:
Practice Address - Street 1:1458 HANCOCK ST
Practice Address - Street 2:SUITE 228
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5214
Practice Address - Country:US
Practice Address - Phone:857-413-6893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELSIOR HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health