Provider Demographics
NPI:1407873342
Name:EXCELSIOR YOUTH CENTERS, INC.
Entity Type:Organization
Organization Name:EXCELSIOR YOUTH CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNWALL
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:303-693-1550
Mailing Address - Street 1:15001 E OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4186
Mailing Address - Country:US
Mailing Address - Phone:303-693-1550
Mailing Address - Fax:303-693-8309
Practice Address - Street 1:15001 E OXFORD AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4186
Practice Address - Country:US
Practice Address - Phone:303-693-1550
Practice Address - Fax:303-693-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
CO45243322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children