Provider Demographics
NPI:1255582763
Name:EXCEL...RISE ABOVE THE REST
Entity type:Organization
Organization Name:EXCEL...RISE ABOVE THE REST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASEMANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALES-LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:210-977-9555
Mailing Address - Street 1:706 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78225-2500
Mailing Address - Country:US
Mailing Address - Phone:210-977-9555
Mailing Address - Fax:210-977-9992
Practice Address - Street 1:706 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78225-2500
Practice Address - Country:US
Practice Address - Phone:210-977-9555
Practice Address - Fax:210-977-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36086251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management