Provider Demographics
NPI:1861852121
Name:EXCELLA DEVELOPMENTAL SERVIES, LLC
Entity Type:Organization
Organization Name:EXCELLA DEVELOPMENTAL SERVIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-307-3585
Mailing Address - Street 1:10555 OLD PLACERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2503
Mailing Address - Country:US
Mailing Address - Phone:916-550-9628
Mailing Address - Fax:
Practice Address - Street 1:10555 OLD PLACERVILLE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2503
Practice Address - Country:US
Practice Address - Phone:916-550-9628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency