Provider Demographics
NPI:1952393316
Name:EXCELLENT HOMECARE PROVIDER SERVICES, INC.
Entity type:Organization
Organization Name:EXCELLENT HOMECARE PROVIDER SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-988-5304
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-1230
Mailing Address - Country:US
Mailing Address - Phone:866-357-8372
Mailing Address - Fax:800-305-2613
Practice Address - Street 1:2900 MOSSROCK
Practice Address - Street 2:SUITE: 370
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5133
Practice Address - Country:US
Practice Address - Phone:866-357-8372
Practice Address - Fax:800-305-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014960251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
741511Medicare Oscar/Certification