Organization
EXCEL FOR LIFE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO JERMAINE JACKSON (DIRECTOR)
(252) 205-0381
Entity
Organization
Contact information
Practice address
1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
(252) 946-4243
(252) 975-8049
Mailing address
1730 CAROLINA AVE, WASHINGTON, NC 27889-3315
(252) 946-4243
(252) 975-8049
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
007044
NC
Other
Enumeration date
11/30/2006
Last updated
08/28/2007
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