Organization
EXCLUSIVE RESIDENTIAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY A. MCMILLION-JACKSON (OWNER)
(251) 423-8197
Entity
Organization
Contact information
Practice address
2117 LUCKNER CT, MOBILE, AL 36618-2618
(251) 341-1764
Mailing address
2117 LUCKNER CT, MOBILE, AL 36618-2618
(251) 341-1764
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/08/2014
Last updated
05/05/2014
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