Provider Demographics
NPI:1003413311
Name:EXCELSIOR SERVICES GROUP LLC
Entity Type:Organization
Organization Name:EXCELSIOR SERVICES GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKESHK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:917-463-6166
Mailing Address - Street 1:91 HELEN CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2015
Mailing Address - Country:US
Mailing Address - Phone:917-463-6166
Mailing Address - Fax:
Practice Address - Street 1:415 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2055
Practice Address - Country:US
Practice Address - Phone:917-463-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities