Provider Demographics
NPI:1912123613
Name:EXCELLACARE
Entity Type:Organization
Organization Name:EXCELLACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:METTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-476-9091
Mailing Address - Street 1:20853 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5183
Mailing Address - Country:US
Mailing Address - Phone:248-476-9091
Mailing Address - Fax:248-476-1011
Practice Address - Street 1:20853 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5183
Practice Address - Country:US
Practice Address - Phone:248-476-9091
Practice Address - Fax:248-476-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2283424251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2283424Medicaid