# EXCELSIOR PRIVATE HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619315694
- **Authorized official:** LILIETH VERINICA PERRY (ADMINISTRATOR)
- **Authorized official phone:** (770) 655-8360

## Contact information

- **Practice address:** 270 TRELAWNEY DR, COVINGTON, GA 30016-6819
- **Practice address phone:** (770) 385-8194
- **Mailing address:** 270 TRELAWNEY DR, COVINGTON, GA 30016-6819
- **Mailing address phone:** (770) 385-8194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 06/12/2013