# EXCELSIOR RANCH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306638119
- **Authorized official:** SOPHIA AGUIRRE (BILLING MANAGER)
- **Authorized official phone:** (563) 243-6054

## Contact information

- **Practice address:** 25777 257TH ST, PRINCETON, IA 52768-9728
- **Practice address phone:** (309) 297-1211
- **Mailing address:** 1523 S BLUFF BLVD, CLINTON, IA 52732-6549
- **Mailing address phone:** (563) 243-6054
- **Mailing address fax:** (563) 243-6828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225XM0800X | Mental Health Occupational Therapist | — | NULL | Yes |
| 225XM0800X | Mental Health Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 05/19/2025
- **Last updated:** 05/19/2025