NPIMap

Organization Active NPI

Excel for Life (Cedar Home)

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Washington, NC
National Provider Identifier
1558547315
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
EXCEL FOR LIFE (CEDAR HOME)
Practice address
108 Cedar Cir
Washington, NC 27889-9506
Phone
(252) 946-1432
NPI assigned
Jan 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

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

Authorized official

Name
Mario Jermaine Jackson, BACHELORS CRIMINAL
Title
Director
Phone
(252) 205-0381

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

108 Cedar Cir
Washington, NC 27889-9506

Mailing address

108 Cedar Cir
Washington, NC 27889-9506
Phone (252) 946-1432

National Provider Directory

National Provider Directory
Tax ID family
Excel for Life LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

108 Cedar Cir
Washington, NC 27889
Phone (252) 205-0381

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200009600000",
    "number": "1558547315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CEDAR CIR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278899506",
            "telephone_number": "252-946-1432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CEDAR CIR",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278899506",
            "telephone_number": "252-946-1432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL FOR LIFE (CEDAR HOME)",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2008-01-11",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "JERMAINE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "252-205-0381",
        "authorized_official_credential": "BACHELORS CRIMINAL"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.