Provider Demographics
NPI:1205518552
Name:EXCELLA HEALTH CENTRE LLC
Entity type:Organization
Organization Name:EXCELLA HEALTH CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KAMARIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-533-0871
Mailing Address - Street 1:4616 N 51ST AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1721
Mailing Address - Country:US
Mailing Address - Phone:407-533-0871
Mailing Address - Fax:
Practice Address - Street 1:4616 N 51ST AVE STE 212
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1721
Practice Address - Country:US
Practice Address - Phone:407-533-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELLA HEALTH CENTRE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)