Provider Demographics
NPI:1730703521
Name:EXCELLENT CARE RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:EXCELLENT CARE RESIDENTIAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:NKUROKO
Authorized Official - Last Name:AMBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-201-5841
Mailing Address - Street 1:6400 RIVINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2912
Mailing Address - Country:US
Mailing Address - Phone:571-201-5841
Mailing Address - Fax:
Practice Address - Street 1:6400 RIVINGTON RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2912
Practice Address - Country:US
Practice Address - Phone:571-201-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management