Provider Demographics
NPI:1689147688
Name:EXCELSIOR SERVICES, INC.
Entity Type:Organization
Organization Name:EXCELSIOR SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKESHK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:917-463-6166
Mailing Address - Street 1:148 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2065
Mailing Address - Country:US
Mailing Address - Phone:917-463-6166
Mailing Address - Fax:
Practice Address - Street 1:148 4TH ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2065
Practice Address - Country:US
Practice Address - Phone:917-463-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services