Organization
EXCEL 4 LIFE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO JACKSON JACKSON B.A CRIMINAL JUSTICE (OWNER/DIRECTOR)
(252) 205-0381
Entity
Organization
Contact information
Practice address
2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
(252) 205-0381
(252) 946-4243
Mailing address
149 N MARKET ST, WASHINGTON, NC 27889-4947
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
007-052
NC
Other
Enumeration date
09/21/2009
Last updated
09/21/2009
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