Provider Demographics
NPI:1104091701
Name:THE EXCEL GROUP
Entity type:Organization
Organization Name:THE EXCEL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP/PNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROUBA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:928-341-0409
Mailing Address - Street 1:106 EAST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-1450
Mailing Address - Country:US
Mailing Address - Phone:928-341-0409
Mailing Address - Fax:928-329-8950
Practice Address - Street 1:106 E 1ST ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-1450
Practice Address - Country:US
Practice Address - Phone:928-341-0409
Practice Address - Fax:928-329-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401029-1310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness