Provider Demographics
NPI:1396452108
Name:EXCEPTIONAL HEALTH CARE PRESCOTT LLC
Entity type:Organization
Organization Name:EXCEPTIONAL HEALTH CARE PRESCOTT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:972-740-9335
Mailing Address - Street 1:3514 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4901
Mailing Address - Country:US
Mailing Address - Phone:469-341-7800
Mailing Address - Fax:806-353-3201
Practice Address - Street 1:4822 E STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6885
Practice Address - Country:US
Practice Address - Phone:972-740-9335
Practice Address - Fax:469-807-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital