Organization
JACKSON FAMILY CARE HOME II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY MCCULLERS JACKSON (OWNER/ADMINISTRATOR)
(919) 266-5291
Entity
Organization
Contact information
Practice address
7112 OUTRIGGER DR, WENDELL, NC 27591-7240
(919) 366-1513
(919) 366-1513
Mailing address
5641 QUAIL COVEY LN, WENDELL, NC 27591-7901
(919) 266-5291
(919) 266-7901
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
FCL092148
NC
Other
Enumeration date
04/26/2009
Last updated
04/26/2009
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