NPIMap

Organization Active NPI

Excelsior Home 1 Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Detroit, MI
National Provider Identifier
1891917191
Registry record updated Aug 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
EXCELSIOR HOME 1 INC.
Practice address
129 Virginia Park
Detroit, MI 48202
Phone
(313) 874-5594
Fax
(248) 208-0024
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kathleen Davis
Title
Administrator
Phone
(313) 874-5404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MI Primary

Addresses

Primary practice location

129 Virginia Park
Detroit, MI 48202

Mailing address

P.O.Box 11387
Detroit, MI 48202
Phone (313) 874-5404

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1891917191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O.BOX 11387",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-874-5404",
            "fax_number": "248-208-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 VIRGINIA PARK",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48202",
            "telephone_number": "313-874-5594",
            "fax_number": "248-208-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCELSIOR HOME 1 INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "313-874-5404",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.