Provider Demographics
NPI:1598444796
Name:EXCEL AUTISM CENTER LLC
Entity Type:Organization
Organization Name:EXCEL AUTISM CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HABSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GULET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-465-5962
Mailing Address - Street 1:118 1ST AVE NE STE 155
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5225
Mailing Address - Country:US
Mailing Address - Phone:952-465-5962
Mailing Address - Fax:
Practice Address - Street 1:118 1ST AVE NE STE 155
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5225
Practice Address - Country:US
Practice Address - Phone:952-465-5962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities