Provider Demographics
NPI:1225728660
Name:EXCELLENCE NOIRE LLC
Entity type:Organization
Organization Name:EXCELLENCE NOIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:607-345-1321
Mailing Address - Street 1:100 CARRINGTON PARK APT 2104
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2888
Mailing Address - Country:US
Mailing Address - Phone:607-346-1321
Mailing Address - Fax:
Practice Address - Street 1:100 CARRINGTON PARK APT 2104
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2888
Practice Address - Country:US
Practice Address - Phone:607-346-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty