Provider Demographics
NPI:1407668015
Name:EXCEL HEAING CENTER LLC
Entity type:Organization
Organization Name:EXCEL HEAING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:435-592-3347
Mailing Address - Street 1:285 W PRAIRIE SHOPPING CTR # 129
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9855
Mailing Address - Country:US
Mailing Address - Phone:208-449-6404
Mailing Address - Fax:
Practice Address - Street 1:7763 N HEATHGRASS LN
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7969
Practice Address - Country:US
Practice Address - Phone:208-449-6404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty