Healthcare Provider Details

I. General information

NPI: 1184550329
Provider Name (Legal Business Name): EXCELL COMMUNITY NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5138 TENNESSEE ST
GARY IN
46409-2957
US

IV. Provider business mailing address

PO BOX 10182
MERRILLVILLE IN
46411-0182
US

V. Phone/Fax

Practice location:
  • Phone: 219-613-4774
  • Fax:
Mailing address:
  • Phone: 219-613-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ERICA WOODLEY
Title or Position: CEO
Credential:
Phone: 219-613-4774