Healthcare Provider Details

I. General information

NPI: 1295472835
Provider Name (Legal Business Name): EXCELSIS ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W SUPERSTITION BLVD
APACHE JUNCTION AZ
85120-4044
US

IV. Provider business mailing address

2522 SUNSTONE LN
PEARLAND TX
77584-3249
US

V. Phone/Fax

Practice location:
  • Phone: 480-625-1938
  • Fax:
Mailing address:
  • Phone: 832-891-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: DR. LEON G HAMILTON
Title or Position: OWNER
Credential: PH.D.
Phone: 832-891-2507