Healthcare Provider Details

I. General information

NPI: 1497420202
Provider Name (Legal Business Name): EXCELLENCE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 01/30/2025
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21248 W ALMERIA RD
BUCKEYE AZ
85396
US

IV. Provider business mailing address

21248 W ALMERIA RD
BUCKEYE AZ
85396
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-7092
  • Fax: 602-445-9361
Mailing address:
  • Phone: 480-438-1122
  • Fax: 602-445-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIK HOLLEMAN
Title or Position: MEMBER
Credential:
Phone: 480-438-1122