NPIMap

Organization Active NPI

Excel for Life, LLC

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Washington, NC
National Provider Identifier
1942377114
Registry record updated Aug 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
007044 Issued in NC
Legal business name
EXCEL FOR LIFE, LLC
Practice address
1730 Carolina Ave
Washington, NC 27889-3315
Phone
(252) 946-4243
Fax
(252) 975-8049
NPI assigned
Nov 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2007

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 007044 NC Primary

Addresses

Primary practice location

1730 Carolina Ave
Washington, NC 27889-3315

Mailing address

1730 Carolina Ave
Washington, NC 27889-3315
Phone (252) 946-4243

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

1730 Carolina Ave
Washington, NC 27889
Phone (252) 946-2171

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188259200000",
    "number": "1942377114",
    "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": "252-946-4243",
            "fax_number": "252-975-8049"
        },
        {
            "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": "252-946-4243",
            "fax_number": "252-975-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL FOR LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-08-28",
        "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"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "007044",
            "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 Aug 28, 2007; 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.