Organization
SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC
Active
Other names
Guardian Care
Organization subpart
No
Provider details
NPI number
Authorized official
MISS CHANTE GISELLE HINES (OFFICE MANAGER)
(910) 265-0304
Entity
Organization
Contact information
Practice address
510 CRISSY DR, JACKSONVILLE, NC 28540-9183
(910) 219-0459
Mailing address
PO BOX 752, JACKSONVILLE, NC 28541-0752
(910) 382-6595
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-067-157
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418119
—
NC
Enumeration date
09/09/2013
Last updated
09/10/2013
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