Provider Demographics
NPI:1861088064
Name:EXCELLENT RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:EXCELLENT RESIDENTIAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTSITSI
Authorized Official - Suffix:
Authorized Official - Credentials:DSP
Authorized Official - Phone:704-777-2188
Mailing Address - Street 1:60 WOODLAND RD APT B5
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1259
Mailing Address - Country:US
Mailing Address - Phone:704-777-2188
Mailing Address - Fax:
Practice Address - Street 1:60 WOODLAND RD APT B5
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1259
Practice Address - Country:US
Practice Address - Phone:704-777-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities