# EXCEL FOR LIFE (CEDAR HOME)

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

## Provider details

- **NPI number:** 1558547315
- **Authorized official:** MARIO JERMAINE JACKSON BACHELORS CRIMINAL (DIRECTOR)
- **Authorized official phone:** (252) 205-0381

## Contact information

- **Practice address:** 108 CEDAR CIR, WASHINGTON, NC 27889-9506
- **Practice address phone:** (252) 946-1432
- **Mailing address:** 108 CEDAR CIR, WASHINGTON, NC 27889-9506
- **Mailing address phone:** (252) 946-1432

## Taxonomy

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

## Other

- **Enumeration date:** 01/11/2008
- **Last updated:** 01/11/2008