Provider Demographics
NPI:1962116913
Name:EXCELSIOR HOME CARESERVICES INC
Entity type:Organization
Organization Name:EXCELSIOR HOME CARESERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNST
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEURANVIL
Authorized Official - Suffix:
Authorized Official - Credentials:PE
Authorized Official - Phone:347-339-6688
Mailing Address - Street 1:18441 NW 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4517
Mailing Address - Country:US
Mailing Address - Phone:305-650-1158
Mailing Address - Fax:305-705-4292
Practice Address - Street 1:18441 NW 2ND AVE STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4517
Practice Address - Country:US
Practice Address - Phone:305-650-1158
Practice Address - Fax:305-705-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09111961Medicaid
FL253Z00000XMedicaid