1316068505 NPI number — EXCEL TUTORING AND PERSONAL DEVELOPMENT

Table of content: (NPI 1316068505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316068505 NPI number — EXCEL TUTORING AND PERSONAL DEVELOPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL TUTORING AND PERSONAL DEVELOPMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EXCEL PERSONAL DEVELOPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316068505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8520 CLIFF CAMERON DR
Provider Second Line Business Mailing Address:
SUITE 460
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28269-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-510-1535
Provider Business Mailing Address Fax Number:
704-940-8060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 N CHARLOTTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28110-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-282-0638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TILLMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-510-1535

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8301806 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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