Provider Demographics
NPI:1861944670
Name:EXCELSIOR HEALTHCARE LLC
Entity type:Organization
Organization Name:EXCELSIOR HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-749-2535
Mailing Address - Street 1:2611 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63106-3914
Mailing Address - Country:US
Mailing Address - Phone:314-899-9950
Mailing Address - Fax:314-899-9949
Practice Address - Street 1:2611 N 14TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-3914
Practice Address - Country:US
Practice Address - Phone:314-899-9950
Practice Address - Fax:314-899-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health