Organization
EXCEL FOR LIFE (CEDAR HOME)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO JERMAINE JACKSON BACHELORS CRIMINAL (DIRECTOR)
(252) 205-0381
Entity
Organization
Contact information
Practice address
108 CEDAR CIR, WASHINGTON, NC 27889-9506
(252) 946-1432
Mailing address
108 CEDAR CIR, WASHINGTON, NC 27889-9506
(252) 946-1432
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/11/2008
Last updated
01/11/2008
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