Provider Demographics
NPI:1174031066
Name:A CENTER FOR EXCELLENCE, LLC
Entity Type:Organization
Organization Name:A CENTER FOR EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DNAP
Authorized Official - Phone:318-469-4470
Mailing Address - Street 1:1717 BENEDICT CT
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-2899
Mailing Address - Country:US
Mailing Address - Phone:318-469-4470
Mailing Address - Fax:
Practice Address - Street 1:9535 FOREST LN STE 271
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5900
Practice Address - Country:US
Practice Address - Phone:318-469-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)