Organization
MARYS MAJOR III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY LILLY MCCULLERS-JACKSON (OWNER ADMINISTRATOR)
(919) 266-5291
Entity
Organization
Contact information
Practice address
4208 LABRADOR DRIVE, RALEIGH, NC 27616-9746
(919) 261-0572
(919) 266-7901
Mailing address
5641 QUAIL COVEY LANE, WENDELL, NC 27591-7901
(919) 266-5291
(919) 266-7901
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
MHL 092 351
NC
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL 092 351
NC
Other
Enumeration date
03/19/2007
Last updated
07/09/2008
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