1568456143 NPI number — EXCELLENT HOME HEALTH CARE INC

Table of content: DR. HOLBERT CLAY HODGES DO (NPI 1447780259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568456143 NPI number — EXCELLENT HOME HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELLENT HOME HEALTH CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568456143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 W OAKTON AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKOKIE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60076-3431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-674-3202
Provider Business Mailing Address Fax Number:
847-674-2719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 W OAKTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOKIE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60076-3431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-674-3202
Provider Business Practice Location Address Fax Number:
847-674-2719
Provider Enumeration Date:
09/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LISING
Authorized Official First Name:
FRUCTOSA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
847-674-3202

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  1010273 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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