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EXCELSIOR INTEGRATED CARE CENTER LLC

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Company Details

Legal Name: EXCELSIOR INTEGRATED CARE CENTER LLC
Jurisdiction: WASHINGTON
Entity Type: WA LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: November 15th 2019
Expiration date: 30 Nov 2025
UBI Number: 604 531 817
ZIP code: 99201
City: Spokane
County: SPOKANE
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 601 W MAIN AVE STE 1400, SPOKANE, WA, 99201-0635, UNITED STATES

Contact Details

E-Mail: RBURNETT@WORKWITH.COM
Phone Number: +1 509-455-9077

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
WBM CORPORATE SERVICES LLC Registered Agent

Key Officers & Management

Name Role Address
ROBERT BURNETT Executor 159 S LINCOLN ST, SUITE 225, SPOKANE, WA, 99201-4418, UNITED STATES
EXCELSIOR WELLNESS Governing Person -

National Provider Identifier

NPI Number:
1326672692
Certification Date:
2020-10-27

Authorized Person:

Name:
DOVIE BRITTON
Role:
CONTRACTING AND CREDENTIALING COORD
Phone:

Taxonomy:

Selected Taxonomy:
261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center
Is Primary:
No
Selected Taxonomy:
323P00000X - Psychiatric Residential Treatment Facility
Is Primary:
No
Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
Yes

Contacts:

Fax:
5093287582
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