Provider Demographics
NPI:1841904588
Name:EXCELLER SUPPORT SOLUTIONS LLC
Entity type:Organization
Organization Name:EXCELLER SUPPORT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER (CEO)
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN GARNON
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIMWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-352-8710
Mailing Address - Street 1:168 LISBON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7234
Mailing Address - Country:US
Mailing Address - Phone:207-310-3101
Mailing Address - Fax:
Practice Address - Street 1:168 LISBON ST FL 2
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7234
Practice Address - Country:US
Practice Address - Phone:207-310-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities