Provider Demographics
NPI:1801776661
Name:EXCELSIOR OMEGA INC.
Entity type:Organization
Organization Name:EXCELSIOR OMEGA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORELIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-807-9657
Mailing Address - Street 1:15 DADE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1608
Mailing Address - Country:US
Mailing Address - Phone:941-371-4091
Mailing Address - Fax:941-282-7673
Practice Address - Street 1:3548 SEA VIEW ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3417
Practice Address - Country:US
Practice Address - Phone:941-807-9657
Practice Address - Fax:941-282-7673
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELSIOR OMEGA INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness