NPIMap

Organization Active NPI

Excel 4 Life, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Washington, NC
National Provider Identifier
1669705596
Registry record updated Sep 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
EXCEL 4 LIFE, INC
Practice address
1730 Carolina Ave
Washington, NC 27889-3315
Phone
(252) 205-0381
Fax
(252) 205-0381
NPI assigned
Sep 10, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2009

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

Authorized official

Name
Mario Jackson, B.A CRIMINAL JUSTICE
Title
Owner/Director
Phone
(252) 205-0381

Specialties & licenses 1

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

Addresses

Primary practice location

1730 Carolina Ave
Washington, NC 27889-3315

Mailing address

1730 Carolina Ave
Washington, NC 27889-3315
Phone (252) 205-0381

National Provider Directory

National Provider Directory
Tax ID family
Excel 4 Life Inc4 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.

NPI Registry JSON

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

{
    "created_epoch": "1252540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252540800000",
    "number": "1669705596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 CAROLINA AVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893315",
            "telephone_number": "252-205-0381",
            "fax_number": "252-205-0381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 CAROLINA AVE",
            "city": "WASHINGTON",
            "state": "NC",
            "postal_code": "278893315",
            "telephone_number": "252-205-0381",
            "fax_number": "252-205-0381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL 4 LIFE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-10",
        "last_updated": "2009-09-10",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "252-205-0381",
        "authorized_official_credential": "B.A CRIMINAL JUSTICE"
    },
    "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 Sep 10, 2009; 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.