Provider Demographics
NPI:1891074597
Name:EXCELTH, INCORPORATED
Entity Type:Organization
Organization Name:EXCELTH, INCORPORATED
Other - Org Name:EXCELTH FAMILY HEALTH CENTER ALGIER-GNOCHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:TREGRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-524-1210
Mailing Address - Street 1:4422 GENERAL MEYER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3588
Mailing Address - Country:US
Mailing Address - Phone:504-526-1179
Mailing Address - Fax:504-526-1200
Practice Address - Street 1:4422 GENERAL MEYER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3588
Practice Address - Country:US
Practice Address - Phone:504-526-1179
Practice Address - Fax:504-526-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)