| Entity Name: | EXCELLENCE HEALTH CARE AT HOME LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Jan 2023 (2 years ago) |
| Document Number: | L23000022612 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 1630 MASON AVE, SUITE C, DAYTONA BEACH, FL, 32117, US |
| Mail Address: | 1630 MASON AVE, SUITE C, DAYTONA BEACH, FL, 32117, US |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336906080 | 2024-02-29 | 2024-02-29 | 1630 MASON AVE STE C, DAYTONA BEACH, FL, 321174503, US | 1630 MASON AVE STE C, DAYTONA BEACH, FL, 321174503, US | |||||||||||||
|
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| Phone | +1 386-238-9064 |
Authorized person
| Name | DR. HUSAM EDDIN |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 3862389064 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| EDDIN HUSAM | Agent | 1630 MASON AVE, DAYTONA BEACH, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| EDDIN HUSAM | Chief Executive Officer | 1630 MASON AVE SUITE C, DAYTONA BEACH, FL, 32117 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| Florida Limited Liability | 2023-01-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
