Provider Demographics
NPI:1104091420
Name:EXCELSIOR COACHING SERVICES
Entity type:Organization
Organization Name:EXCELSIOR COACHING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EFFRED
Authorized Official - Middle Name:W
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-618-8839
Mailing Address - Street 1:942 BELVOIR DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8227
Mailing Address - Country:US
Mailing Address - Phone:863-618-8839
Mailing Address - Fax:863-594-1375
Practice Address - Street 1:942 BELVOIR DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8227
Practice Address - Country:US
Practice Address - Phone:863-618-8839
Practice Address - Fax:863-594-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6935711 98Medicaid