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General NPI Number Information
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NPI Number | 1396452108
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Entity Type | Organization
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Legal Business Name | EXCEPTIONAL HEALTH CARE PRESCOTT LLC
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 4822 E STATE ROUTE 69
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City | PRESCOTT
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State | AZ
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Zip | 86301-6885
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Country | US
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Telephone | 972-740-9335
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Fax | 469-807-1208
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Provider Business Mailing Address
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Address Line | 3514 CEDAR SPRINGS RD
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City | DALLAS
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State | TX
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Zip | 75219-4901
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Country | US
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Telephone | 469-341-7800
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Fax | 806-353-3201
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | MR. RONALD IVAN COLLINS
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Credential | CPA
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Telephone | 972-740-9335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number |
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License Number State |
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