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Organization

EXCEL 4 LIFE, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIO JACKSON B.A CRIMINAL JUSTICE (OWNER/DIRECTOR)
(252) 205-0381
Entity
Organization

Contact information

Practice address
1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
(252) 205-0381
(252) 205-0381
Mailing address
1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
(252) 205-0381
(252) 205-0381

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary

Other

Enumeration date
09/10/2009
Last updated
09/10/2009
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