Provider Demographics
NPI:1174923544
Name:EXCELCARE INC
Entity type:Organization
Organization Name:EXCELCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-417-7023
Mailing Address - Street 1:12526 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2166
Mailing Address - Country:US
Mailing Address - Phone:714-554-1111
Mailing Address - Fax:714-554-7777
Practice Address - Street 1:12526 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2166
Practice Address - Country:US
Practice Address - Phone:714-554-1111
Practice Address - Fax:714-554-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY524913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150972OtherPK
CA1174923544Medicaid