Active NPI
Mary L McCullers-Jackson
- Mental Illness Community Based Residential Treatment Facility
- Zebulon, NC
National Provider Identifier
1912021486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Illness Community Based Residential Treatment Facility
- License
- MHL 092 516
- Legal business name
- MARY L MCCULLERS-JACKSON
- Practice address
- 501 Bunn St
Zebulon, NC 27597-9177 - Phone
- (919) 269-3060
- Fax
- (919) 266-7901
- NPI assigned
- Mar 19, 2007
- Reactivated
- Jun 19, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Mary Lilly McCullers Jackson
- Title
- Owner Administrator
- Phone
- (919) 266-5291
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | MHL092516 | NC | |
| Mental Illness Community Based Residential Treatment Facility | 320800000X | MHL 092 516 | NC | Primary |
Addresses
Primary practice location
501 Bunn St
Zebulon, NC 27597-9177
Mailing address
5641 Quail Covey Lane
Wendell, NC 27591-7901
Phone (919) 266-5291
National Provider Directory
National Provider Directory- Tax ID family
- Mary L McCullers-Jackson
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Community/Behavioral Health Agency
- Zebulon, NC
- NPI 1326162363
-
- Mental Illness Community Based Residential Treatment Facility
- Raleigh, NC
- NPI 1891819389
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1214438400000",
"number": "1912021486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5641 QUAIL COVEY LANE",
"city": "WENDELL",
"state": "NC",
"postal_code": "275917901",
"telephone_number": "919-266-5291",
"fax_number": "919-266-7901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 BUNN ST",
"city": "ZEBULON",
"state": "NC",
"postal_code": "275979177",
"telephone_number": "919-269-3060",
"fax_number": "919-266-7901"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARY L MCCULLERS-JACKSON",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-19",
"last_updated": "2008-06-26",
"deactivation_date": "2008-06-03",
"reactivation_date": "2008-06-19",
"status": "A",
"authorized_official_last_name": "MCCULLERS JACKSON",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "LILLY",
"authorized_official_title_or_position": "OWNER ADMINISTRATOR",
"authorized_official_telephone_number": "919-266-5291",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "NC",
"license": "MHL092516",
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NC",
"license": "MHL 092 516",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zebulon, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 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.