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General NPI Number Information
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NPI Number | 1306638119
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Entity Type | Organization
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Legal Business Name | EXCELSIOR RANCH
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 25777 257TH ST
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City | PRINCETON
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State | IA
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Zip | 52768-9728
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Country | US
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Telephone | 309-297-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 S BLUFF BLVD
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City | CLINTON
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State | IA
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Zip | 52732-6549
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Country | US
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Telephone | 563-243-6054
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Fax | 563-243-6828
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SOPHIA AGUIRRE
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Credential |
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Telephone | 563-243-6054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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