Provider Demographics
NPI:1053688507
Name:EXCEL TREATMENT CENTER
Entity Type:Organization
Organization Name:EXCEL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:POLITO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW LCADC
Authorized Official - Phone:973-879-3076
Mailing Address - Street 1:477 STATE ROUTE 10 STE 206
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2147
Mailing Address - Country:US
Mailing Address - Phone:973-879-3076
Mailing Address - Fax:
Practice Address - Street 1:477 STATE ROUTE 10 STE 206
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2147
Practice Address - Country:US
Practice Address - Phone:973-879-3076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health