Healthcare Provider Details

I. General information

NPI: 1407873342
Provider Name (Legal Business Name): EXCELSIOR YOUTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15001 E OXFORD AVE
AURORA CO
80014-4186
US

IV. Provider business mailing address

15001 E OXFORD AVE
AURORA CO
80014-4186
US

V. Phone/Fax

Practice location:
  • Phone: 303-693-1550
  • Fax: 303-693-8309
Mailing address:
  • Phone: 303-693-1550
  • Fax: 303-693-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number45243
License Number StateCO

VIII. Authorized Official

Name: KYLE TURNWALL II
Title or Position: CFO
Credential:
Phone: 303-693-1550