Provider Demographics
NPI:1730692997
Name:EXCELSIOR HEALTHCARE II LLC
Entity type:Organization
Organization Name:EXCELSIOR HEALTHCARE II LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-267-4004
Mailing Address - Street 1:4841 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-2013
Mailing Address - Country:US
Mailing Address - Phone:314-267-4004
Mailing Address - Fax:314-899-9949
Practice Address - Street 1:4841 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-2013
Practice Address - Country:US
Practice Address - Phone:314-267-4004
Practice Address - Fax:314-899-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health