Provider Demographics
NPI:1174335426
Name:EXCENTRA CONSULTING LLC
Entity type:Organization
Organization Name:EXCENTRA CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:CIES
Authorized Official - Last Name:DEPUE
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:602-451-4799
Mailing Address - Street 1:8947 E QUILL ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-9724
Mailing Address - Country:US
Mailing Address - Phone:602-451-4799
Mailing Address - Fax:
Practice Address - Street 1:8947 E QUILL ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-9724
Practice Address - Country:US
Practice Address - Phone:602-451-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services