Provider Demographics
NPI:1326672692
Name:EXCELSIOR INTEGRATED CARE CENTER LLC
Entity Type:Organization
Organization Name:EXCELSIOR INTEGRATED CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING AND CREDENTIALING COORD
Authorized Official - Prefix:
Authorized Official - First Name:DOVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-559-3132
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4736
Mailing Address - Country:US
Mailing Address - Phone:509-559-3100
Mailing Address - Fax:509-328-7582
Practice Address - Street 1:3910 W. INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4739
Practice Address - Country:US
Practice Address - Phone:509-559-3100
Practice Address - Fax:509-328-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility