Organization
EXCEL FOR LIFE, LLC (CHERRYRUN HOME)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO JERMAINE JACKSON CRIMINAL JUSTICE (DIRECTOR)
(252) 205-0381
Entity
Organization
Contact information
Practice address
2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
(252) 946-8069
(252) 205-0381
Mailing address
2310 CHERRY RUN RD, WASHINGTON, NC 27889-8366
(252) 946-8069
(252) 205-0381
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
007052
NC
Other
Enumeration date
12/06/2006
Last updated
08/22/2020
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