Spirit of Excellence Community Outreach, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-067-157 Issued in NC

Legal business name

SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC

Doing business as

Guardian Care

Practice address

510 Crissy Dr
Jacksonville, NC 28540-9183

Phone

(910) 219-0459

NPI assigned

Sep 9, 2013

Last updated

Sep 10, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Chante Giselle Hines

Title

Office Manager

Phone

(910) 265-0304

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Guardian Care Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378771200000",
    "number": "1508291683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 752",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285410752",
            "telephone_number": "910-382-6595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 CRISSY DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285409183",
            "telephone_number": "910-219-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-09",
        "last_updated": "2013-09-10",
        "status": "A",
        "authorized_official_last_name": "HINES",
        "authorized_official_first_name": "CHANTE",
        "authorized_official_middle_name": "GISELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "910-265-0304",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-067-157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418119",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guardian Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.