Provider Demographics
NPI:1285976340
Name:EXCELLENT LIFE DESIGN CORPORATION
Entity type:Organization
Organization Name:EXCELLENT LIFE DESIGN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-536-5120
Mailing Address - Street 1:1540 INTERNATIONAL PKWY
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5096
Mailing Address - Country:US
Mailing Address - Phone:407-536-5120
Mailing Address - Fax:810-222-0685
Practice Address - Street 1:1540 INTERNATIONAL PKWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5096
Practice Address - Country:US
Practice Address - Phone:407-536-5120
Practice Address - Fax:810-222-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2629251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health