Healthcare Provider Details

I. General information

NPI: 1275210213
Provider Name (Legal Business Name): OHIO EXCEL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 SHAKER BLVD STE 204
CLEVELAND OH
44120-1927
US

IV. Provider business mailing address

11811 SHAKER BLVD STE 204
CLEVELAND OH
44120-1927
US

V. Phone/Fax

Practice location:
  • Phone: 225-610-5376
  • Fax: 225-361-0483
Mailing address:
  • Phone: 225-610-5376
  • Fax: 225-361-0483

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DICKSON E IDUSUYI
Title or Position: CEO
Credential:
Phone: 225-610-5376