Provider Demographics
NPI:1508940685
Name:THE EXCEL GROUP
Entity Type:Organization
Organization Name:THE EXCEL GROUP
Other - Org Name:CASA DE ESPERANZA GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARR
Authorized Official - Suffix:VIII
Authorized Official - Credentials:
Authorized Official - Phone:928-341-0335
Mailing Address - Street 1:3250A E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7748
Mailing Address - Country:US
Mailing Address - Phone:928-641-0335
Mailing Address - Fax:928-539-7099
Practice Address - Street 1:3180 E 40TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7772
Practice Address - Country:US
Practice Address - Phone:928-341-0335
Practice Address - Fax:928-344-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-1554320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ437443Medicaid
AZZWCKBSMedicare PIN