Provider Demographics
NPI:1174806954
Name:XCELLENT INVESTMENTS
Entity type:Organization
Organization Name:XCELLENT INVESTMENTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:WADDY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:708-331-8148
Mailing Address - Street 1:801 E 169TH PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3033
Mailing Address - Country:US
Mailing Address - Phone:708-331-8148
Mailing Address - Fax:
Practice Address - Street 1:801 E 169TH PL
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3033
Practice Address - Country:US
Practice Address - Phone:708-331-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011298251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health