Exclusive Residential Service LLC

Primary specialty

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

Legal business name

EXCLUSIVE RESIDENTIAL SERVICE LLC

Practice address

2117 Luckner CT
Mobile, AL 36618-2618

Phone

(251) 341-1764

NPI assigned

Apr 8, 2014

Organization subpart

No

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

Authorized official

Name

Shirley A. McMillion-Jackson

Title

Owner

Phone

(251) 423-8197

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shirley McMillan Jackson

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Mobile, AL
  • NPI 1063838878

  Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD (past)

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

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399248000000",
    "number": "1700205705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 LUCKNER CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366182618",
            "telephone_number": "251-341-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 LUCKNER CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366182618",
            "telephone_number": "251-341-1764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCLUSIVE RESIDENTIAL SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-08",
        "last_updated": "2014-05-05",
        "status": "A",
        "authorized_official_last_name": "MCMILLION-JACKSON",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-423-8197"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Mobile, AL
• Providers in Mobile, AL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2014; 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.