Provider Demographics
NPI:1720419732
Name:THE EXCELLENCE GROUP, LLC
Entity Type:Organization
Organization Name:THE EXCELLENCE GROUP, LLC
Other - Org Name:THE RAPHA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEKELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:708-359-9899
Mailing Address - Street 1:1102 E 46TH ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-4435
Mailing Address - Country:US
Mailing Address - Phone:708-359-9899
Mailing Address - Fax:
Practice Address - Street 1:1102 E 46TH ST UNIT 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4435
Practice Address - Country:US
Practice Address - Phone:708-359-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:T.R.S.E, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012853261QP2000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No305S00000XManaged Care OrganizationsPoint of Service