Provider Demographics
NPI:1992323547
Name:EXCELLENT HOME HEALTH
Entity type:Organization
Organization Name:EXCELLENT HOME HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRISLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NTOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-998-1324
Mailing Address - Street 1:2950 E OLD SETTLERS BLVD UNIT 44
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2478
Mailing Address - Country:US
Mailing Address - Phone:512-998-1324
Mailing Address - Fax:
Practice Address - Street 1:2950 E OLD SETTLERS BLVD UNIT 44
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2478
Practice Address - Country:US
Practice Address - Phone:512-998-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health