Organization
GENEXT LIFE LLC
Active
Organization
GENEXT LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ECAROH JACKSON (MANAGING MEMBER)
(404) 642-4493
Entity
Organization
Contact information
Practice address
225 SANDY AVE, CHARLOTTE, NC 28213-5659
(980) 705-1190
Mailing address
1235 EAST BLVD STE E, CHARLOTTE, NC 28203-5876
(980) 705-1190
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
09/20/2023
Last updated
05/11/2026
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