Provider Demographics
NPI:1366127417
Name:EXCEL HEALTHCARE LLC
Entity type:Organization
Organization Name:EXCEL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ESSA
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-537-5549
Mailing Address - Street 1:12733 W DESERT FLOWER RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-7005
Mailing Address - Country:US
Mailing Address - Phone:206-537-5549
Mailing Address - Fax:
Practice Address - Street 1:12733 W DESERT FLOWER RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-7005
Practice Address - Country:US
Practice Address - Phone:206-537-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health