# EXCEL 4 LIFE, INC

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

## Provider details

- **NPI number:** 1487988788
- **Authorized official:** MARIO JACKSON JACKSON B.A CRIMINAL JUSTICE (OWNER/DIRECTOR)
- **Authorized official phone:** (252) 205-0381

## Contact information

- **Practice address:** 2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
- **Practice address phone:** (252) 205-0381
- **Practice address fax:** (252) 946-4243
- **Mailing address:** 149 N MARKET ST, WASHINGTON, NC 27889-4947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 007-052 | NC | Yes |

## Other

- **Enumeration date:** 09/21/2009
- **Last updated:** 09/21/2009