Provider Demographics
NPI:1396196861
Name:EXCEL HOSPITALITY GROUP, LLC
Entity Type:Organization
Organization Name:EXCEL HOSPITALITY GROUP, LLC
Other - Org Name:REGENCY PARK ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIKRUM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-662-1017
Mailing Address - Street 1:15000 N HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6589
Mailing Address - Country:US
Mailing Address - Phone:352-609-2040
Mailing Address - Fax:352-609-2041
Practice Address - Street 1:15000 N HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6589
Practice Address - Country:US
Practice Address - Phone:352-609-2040
Practice Address - Fax:352-609-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL17250310400000X, 311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)