Provider Demographics
NPI:1114469517
Name:EXCELTH, INC
Entity Type:Organization
Organization Name:EXCELTH, INC
Other - Org Name:GEORGE WASHINGTON CARVER COLLEGIATE ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNESSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-524-1210
Mailing Address - Street 1:1515 POYDRAS ST STE 1070
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-4520
Mailing Address - Country:US
Mailing Address - Phone:504-521-1210
Mailing Address - Fax:504-524-1491
Practice Address - Street 1:3059 HIGGINS BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-5422
Practice Address - Country:US
Practice Address - Phone:504-524-1210
Practice Address - Fax:504-524-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty