Basic Information
| Provider Information | |||||||||
| NPI: | 1033177720 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCELLA HEALTHCARE, INC. | ||||||||
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| OtherOrganizationName: | ENCOMPASS HOME HEALTH OF NEW ENGLAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6688 N CENTRAL EXPRESSWAY | ||||||||
| Address2: | SUITE 1300 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752063950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142396500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35 NEW ENGLAND BUSINESS CENTER DR., SUITE 207 | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018101071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783884500 | ||||||||
| FaxNumber: | 9783888255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARBUCKLE | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, LICENSING & ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 2142396501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 626465 | 01 | MA | HARVARD PILGRIM HEALTHCAR | OTHER | 9729020 | 05 | MA | MEDICAID | Y61335 | 01 | MA | BLUE CROSS PT | OTHER | 694563 | 01 | MA | TUFTS HEALTH PLAN | OTHER | OG0009 | 01 | MA | BLUE CROSS OT | OTHER |