Active NPI
Spirit of Excellence Community Outreach,Inc.
Doing business as Guardian Care 1, 2, 3, 4, Changing Lives, Safe Haven,Bridge of Hope
- Home Health Agency
- Jacksonville, NC
National Provider Identifier
1942333240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.
- Doing business as
- Guardian Care 1, 2, 3, 4, Changing Lives, Safe Haven,Bridge of Hope
- Practice address
- 123 Henderson Dr
Jacksonville, NC 28540-5601 - Phone
- (910) 939-4663
- Fax
- (910) 939-5079
- NPI assigned
- Mar 14, 2007
- Last updated
- Feb 2, 2015
- 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
- Mrs. Helen Delorise Fludd
- Title
- Ceo
- Phone
- (910) 382-6595
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 9
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | NU | ||
| Home Health Agency | 251E00000X | NU | Primary | |
| Developmental Disabilities Clinic/Center | 261QD1600X | NU | ||
| Adult Mental Health Clinic/Center | 261QM0850X | NU | ||
| Adult Care Home Facility | 311ZA0620X | NU | ||
| Mental Illness Community Based Residential Treatment Facility | 320800000X | NU | ||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | NU | ||
| Psychiatric Residential Treatment Facility | 323P00000X | MHL-067-164 | NC | |
| Community/Behavioral Health Agency | 251S00000X | NU |
Addresses
Primary practice location
123 Henderson Dr
Jacksonville, NC 28540-5601
Mailing address
PO Box 752
Jacksonville, NC 28541-0752
Phone (910) 939-4663
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6601227 | Medicaid | NC | |
| 6602173 | Medicaid | NC | |
| 8301352G | Medicaid | NC | |
| 3418119 | Medicaid | NC | |
| 009EJ | Other | NC | BLUE CROSS BLUE SHIELD |
| 8301352 | Medicaid | NC | |
| 8301352B | Medicaid | NC | |
| 001GM | Other | NC | BLUE CROSS BLUE SHIELD |
| 3408311 | Medicaid | NC | |
| 6006360 | Medicaid | NC | |
| 7805061 | Medicaid | NC |
Other names 1
- Guardian Care 1, 2, 3, 4, Changing Lives, Safe Haven,Bridge of Hope
National Provider Directory
National Provider DirectoryLocations
123 Henderson Dr
Jacksonville, NC 28540
Phone (910) 353-5555
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Mental Health Counselor
- Jacksonville, NC
- NPI 1194525311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173830400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1422835200000",
"number": "1942333240",
"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": "910-939-4663",
"fax_number": "910-939-5079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 HENDERSON DR",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285405601",
"telephone_number": "910-939-4663",
"fax_number": "910-939-5079"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-14",
"last_updated": "2015-02-02",
"status": "A",
"authorized_official_last_name": "FLUDD",
"authorized_official_first_name": "HELEN",
"authorized_official_middle_name": "DELORISE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "910-382-6595",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "261QM0850X",
"taxonomy_group": "",
"desc": "Clinic/Center, Adult Mental Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "320800000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Mental Illness",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "323P00000X",
"taxonomy_group": "",
"desc": "Psychiatric Residential Treatment Facility",
"state": "NC",
"license": "MHL-067-164",
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6601227",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6602173",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301352G",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3418119",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "009EJ",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301352",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8301352B",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "001GM",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3408311",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6006360",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7805061",
"state": "NC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Guardian Care 1, 2, 3, 4, Changing Lives, Safe Haven,Bridge of Hope",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.