Provider Demographics
NPI:1427484278
Name:EXCELLENT HOMECARE OF SOUTH JERSEY
Entity type:Organization
Organization Name:EXCELLENT HOMECARE OF SOUTH JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-440-9160
Mailing Address - Street 1:1199 E PARK AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3369
Mailing Address - Country:US
Mailing Address - Phone:856-265-0710
Mailing Address - Fax:
Practice Address - Street 1:1199 E PARK AVE
Practice Address - Street 2:SUITE B
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3369
Practice Address - Country:US
Practice Address - Phone:856-265-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0179000251E00000X
NJHP0179200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health