Basic Information
| Provider Information | |||||||||
| NPI: | 1407873342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCELSIOR YOUTH CENTERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15001 E OXFORD AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800144186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036931550 | ||||||||
| FaxNumber: | 3036938309 | ||||||||
| Practice Location | |||||||||
| Address1: | 15001 E OXFORD AVE | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800144186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036931550 | ||||||||
| FaxNumber: | 3036938309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 08/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | TURNWALL | ||||||||
| AuthorizedOfficialFirstName: | KYLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3036931550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | II | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 322D00000X | 45243 | CO | N | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.