Provider Demographics
NPI:1861639882
Name:EXCELLENT ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:EXCELLENT ADULT FAMILY CARE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHALIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-455-2455
Mailing Address - Street 1:4240 SW45TH COURT STREET
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9611
Mailing Address - Country:US
Mailing Address - Phone:352-433-2455
Mailing Address - Fax:325-433-2455
Practice Address - Street 1:4240 SW45TH COURT STR.
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-9611
Practice Address - Country:US
Practice Address - Phone:352-433-2455
Practice Address - Fax:325-433-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL693200296253Z00000X, 385HR2060X
FL69320096261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities