Provider Demographics
NPI:1689728628
Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Other - Org Name:EXCEL PERSONAL DEVELOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-635-7766
Mailing Address - Street 1:1502 N CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2500
Mailing Address - Country:US
Mailing Address - Phone:704-635-7766
Mailing Address - Fax:704-635-7779
Practice Address - Street 1:1127 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5057
Practice Address - Country:US
Practice Address - Phone:704-226-0180
Practice Address - Fax:704-226-0158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901774Medicaid
NC8300847Medicaid
NC5901775Medicaid
NC6005464Medicaid
NC8300849Medicaid
NC8301806Medicaid
NC8300761Medicaid
NC8300763Medicaid
NC6005274Medicaid
NC6005275Medicaid
NC8300762Medicaid
NC6005276Medicaid
NC8300848Medicaid
NC8301807Medicaid