Provider Demographics
NPI:1447997051
Name:EXCELSIOR HOLDINGS
Entity type:Organization
Organization Name:EXCELSIOR HOLDINGS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:416-510-3006
Mailing Address - Street 1:PO BOX 161719
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-1719
Mailing Address - Country:US
Mailing Address - Phone:406-510-3006
Mailing Address - Fax:
Practice Address - Street 1:285 SIMKINS DR.
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59730
Practice Address - Country:US
Practice Address - Phone:406-510-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXCELSIOR HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty