Healthcare Provider Details

I. General information

NPI: 1326267055
Provider Name (Legal Business Name): EXCELSIOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

IV. Provider business mailing address

3754 W INDIAN TRAIL RD
SPOKANE WA
99208-4736
US

V. Phone/Fax

Practice location:
  • Phone: 509-328-7041
  • Fax: 509-328-7582
Mailing address:
  • Phone: 509-559-3100
  • Fax: 509-328-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number32 0893 00 / 181
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number32 0893 00 / 181
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number32 0893 00 / 181
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number32 0893 00 / 181
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number32 0893 00 / 181
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number32 0893 00 / 181
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number32 0893 00 / 181
License Number StateWA
# 8
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number32 0893 00 / 181
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number32 0893 00 / 181
License Number StateWA

VIII. Authorized Official

Name: ANDREW R HILL
Title or Position: CEO/PRESIDENT
Credential: MS, LMHC, CMHS, RRT
Phone: 509-328-7041