Healthcare Provider Details

I. General information

NPI: 1154589802
Provider Name (Legal Business Name): EXCELLENCE IN EVERYONE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N BRIDGE ST
SAINT ANTHONY ID
83445-5005
US

IV. Provider business mailing address

PO BOX 154
SAINT ANTHONY ID
83445-0154
US

V. Phone/Fax

Practice location:
  • Phone: 208-390-3652
  • Fax:
Mailing address:
  • Phone: 208-390-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER DAWN BENNETT
Title or Position: MANAGER
Credential:
Phone: 208-390-3652