Provider Demographics
NPI:1841971397
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 1:5518 W CARSON RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2270
Mailing Address - Country:US
Mailing Address - Phone:407-533-0871
Mailing Address - Fax:
Practice Address - Street 1:4616 N 51ST AVE # 218
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1716
Practice Address - Country:US
Practice Address - Phone:407-533-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty