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General NPI Number Information
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NPI Number | 1295472835
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Entity Type | Organization
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Legal Business Name | EXCELSIS ASSISTED LIVING
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 1111 W SUPERSTITION BLVD
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City | APACHE JUNCTION
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State | AZ
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Zip | 85120-4044
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Country | US
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Telephone | 480-625-1938
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 SUNSTONE LN
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City | PEARLAND
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State | TX
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Zip | 77584-3249
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Country | US
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Telephone | 832-891-2507
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEON G HAMILTON
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Credential | PH.D.
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Telephone | 832-891-2507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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