Healthcare Provider Details

I. General information

NPI: 1396196861
Provider Name (Legal Business Name): EXCEL HOSPITALITY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 N HIGHWAY 441
EUSTIS FL
32726-6589
US

IV. Provider business mailing address

15000 N HIGHWAY 441
EUSTIS FL
32726-6589
US

V. Phone/Fax

Practice location:
  • Phone: 352-609-2040
  • Fax: 352-609-2041
Mailing address:
  • Phone: 352-609-2040
  • Fax: 352-609-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL17250
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL17250
License Number StateFL

VIII. Authorized Official

Name: VIKRUM PATEL
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 321-662-1017