Provider Demographics
NPI:1124519525
Name:EXCELLENT CARE PROFESSIONALS
Entity type:Organization
Organization Name:EXCELLENT CARE PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:412-330-8439
Mailing Address - Street 1:1201 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4703
Mailing Address - Country:US
Mailing Address - Phone:412-488-9009
Mailing Address - Fax:412-488-6331
Practice Address - Street 1:1201 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4703
Practice Address - Country:US
Practice Address - Phone:412-488-9009
Practice Address - Fax:412-488-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA37283601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care