Provider Demographics
NPI:1336876937
Name:EXCELLENT PROFESSIONAL HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:EXCELLENT PROFESSIONAL HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:W
Authorized Official - Last Name:NENE
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:314-827-8690
Mailing Address - Street 1:1127 INDIAN TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3109
Mailing Address - Country:US
Mailing Address - Phone:314-827-8690
Mailing Address - Fax:314-827-8690
Practice Address - Street 1:1127 INDIAN TRAILS DR
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3109
Practice Address - Country:US
Practice Address - Phone:314-827-8690
Practice Address - Fax:314-827-8690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health