Provider Demographics
NPI:1295472835
Name:EXCELSIS ASSISTED LIVING
Entity type:Organization
Organization Name:EXCELSIS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-891-2507
Mailing Address - Street 1:2522 SUNSTONE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3249
Mailing Address - Country:US
Mailing Address - Phone:832-891-2507
Mailing Address - Fax:
Practice Address - Street 1:1111 W SUPERSTITION BLVD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-4044
Practice Address - Country:US
Practice Address - Phone:480-625-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty