Provider Demographics
NPI:1336230689
Name:EXCEL HOME HEALTH
Entity type:Organization
Organization Name:EXCEL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOPAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-460-6622
Mailing Address - Street 1:5575 LAKE PARK WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-460-6622
Mailing Address - Fax:619-460-6873
Practice Address - Street 1:5575 LAKE PARK WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-460-6622
Practice Address - Fax:619-460-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA57494FMedicaid
CAHHA57494FMedicaid