Provider Demographics
NPI:1932170081
Name:EXCELA HEALTH DIVERSIFIED SERVICES, INC.
Entity Type:Organization
Organization Name:EXCELA HEALTH DIVERSIFIED SERVICES, INC.
Other - Org Name:MEDCARE EQUIPMENT COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTENDREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-850-6903
Mailing Address - Street 1:501 W OTTERMAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2126
Mailing Address - Country:US
Mailing Address - Phone:724-850-6903
Mailing Address - Fax:724-850-6941
Practice Address - Street 1:443 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2236
Practice Address - Country:US
Practice Address - Phone:724-830-8650
Practice Address - Fax:724-836-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA65382532332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007733490006Medicaid
PA0460650001Medicare NSC