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Organization
EXCEL FOR LIFE, LLC (CHERRYRUN HOME)
Active
Organization
EXCEL FOR LIFE, LLC (CHERRYRUN HOME)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO JERMAINE JACKSON CRIMINAL JUSTICE (DIRECTOR)
(252) 205-0381
Entity
Organization
Contact information
Practice address
2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
(252) 946-8069
(252) 205-0381
Mailing address
2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
(252) 946-8069
(252) 205-0381
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
007052
NC
Other
Enumeration date
12/06/2006
Last updated
08/22/2020
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