Basic Information
| Provider Information | |||||||||
| NPI: | 1952481814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE EXCEL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3250A E 40TH ST | ||||||||
| Address2: | |||||||||
| City: | YUMA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853657748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283410335 | ||||||||
| FaxNumber: | 9285397099 | ||||||||
| Practice Location | |||||||||
| Address1: | 28671 LOS ANGELES AVENUE | ||||||||
| Address2: | |||||||||
| City: | WELLTON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853560179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287859426 | ||||||||
| FaxNumber: | 9287859462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 10/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | CARON | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9283410335 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | BH-2037 | AZ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 707185 | 05 | AZ | MEDICAID |