Provider Demographics
NPI:1275210213
Name:OHIO EXCEL CARE
Entity Type:Organization
Organization Name:OHIO EXCEL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:E
Authorized Official - Last Name:IDUSUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-610-5376
Mailing Address - Street 1:11811 SHAKER BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1927
Mailing Address - Country:US
Mailing Address - Phone:225-610-5376
Mailing Address - Fax:225-361-0483
Practice Address - Street 1:11811 SHAKER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1927
Practice Address - Country:US
Practice Address - Phone:225-610-5376
Practice Address - Fax:225-361-0483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health