Provider Demographics
NPI:1326267055
Name:EXCELSIOR WELLNESS
Entity type:Organization
Organization Name:EXCELSIOR WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, CMHS, RRT
Authorized Official - Phone:509-328-7041
Mailing Address - Street 1:3754 W INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4736
Mailing Address - Country:US
Mailing Address - Phone:509-559-3100
Mailing Address - Fax:509-328-7582
Practice Address - Street 1:3754 W INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4736
Practice Address - Country:US
Practice Address - Phone:509-328-7041
Practice Address - Fax:509-328-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA32 0893 00 / 181251B00000X, 251C00000X, 261QM0801X, 261QM0855X, 261QR0405X, 320800000X, 322D00000X, 323P00000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1993435Medicaid
WA1007885Medicaid
WA2015145Medicaid
WA450639Medicaid