SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC (NPI# 1508291683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508291683 |
| Entity Type | Organization |
| Organization Name | SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC |
| Other Organization Name | GUARDIAN CARE |
| Practice Address |
510 Crissy Dr Jacksonville NC 28540-9183 |
| Mailing Address |
Po Box 752 Jacksonville NC 28541-0752 |
| Practice Telephone | 9102190459 |
| Mailing Telephone | 9103826595 |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-10 |
| Authorized Official Name | MISS CHANTE GISELLE HINES (OFFICE MANAGER) |
| Authorized Official Telephone | 9102650304 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | NC | Residential Treatment Facilities | |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | MHL-067-157 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 3418119 | 05 |
| Other Name | Type Code |
|---|---|
| Guardian Care | Doing Business As Name - Organization |
| Street Address |
510 CRISSY DR |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28540-9183 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467067785 | Knox Counseling and Consulting, PC | Case Management | 513 New Bridge St-suite 500, Jacksonville, NC 28540 | 2020-09-14 |
| 1629696646 | Mary Ann Caldwell | Counselor | 2496 Northwoods Dr., Jacksonville, NC 28540 | 2020-07-07 |
| 1639793748 | Johnathon T Brewer | Military Health Care Provider | 100 White St, Jacksonville, NC 28540 | 2020-06-04 |
| 1043782899 | Brice Rivra | Military Health Care Provider | Rr 612 Loop Road, Jacsksonvile, NC 28540 | 2018-12-18 |
| 1649768599 | Alexander John Pybus | Student in an Organized Health Care Education/Training Program | White St Bldg As-100, Jacksonville, NC 28540 | 2018-04-26 |
| 1881198182 | Orleiquis Guerra | Military Health Care Provider | Marine Corps Air Station New River Bldg As-100, Jacksonville, NC 28540 | 2018-03-21 |
| 1558864736 | Andrew Louis Monroe | General Practice | As-100 White Street, Jacksonville, NC 28540 | 2018-03-14 |
| 1588183198 | Citizen Community Transport, LLC | Private Vehicle | 220 Foxwood Ct., Jacksonville, NC 28540 | 2017-09-14 |
| 1558886242 | Brandon Jay Smith | Military Health Care Provider | E Street Bldg G770, Camp Lejeune, NC 28540 | 2017-08-03 |
| 1174043244 | Jason Waters | Military Health Care Provider | White St, Bldg As-100, Jacksonville, NC 28540 | 2017-06-21 |
| Find all providers in zip 28540 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124628565 | Rachelle Homehealth Care LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8539 Gate Pkwy W Unit 9134, Jacksonville, FL 32216-1037 | 2020-10-26 |
| 1306459359 | Joy-little Enterprise LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 9148 Ridge Blvd, Jacksonville, FL 32208-1265 | 2020-08-28 |
| 1346873882 | Cojo Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3825 Leonard Cir W, Jacksonville, FL 32209-3754 | 2020-02-12 |
| 1306497672 | Tamara Belcher-bostick | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2020 Almira St, Jacksonville, FL 32211-4604 | 2019-09-26 |
| 1235786856 | Mary Imhansiemhonehi | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4568 Antler Hill Dr E, Jacksonville, FL 32224-8704 | 2019-08-19 |
| 1942866611 | Linda R Siplin-kerrin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11855 Alexandra Dr, Jacksonville, FL 32218-8878 | 2019-05-17 |
| 1417414053 | Danx Group LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6859 Lenox Ave # 32, Jacksonville, FL 32205-6149 | 2019-03-01 |
| 1558834879 | Annquenette C Daniels | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6859 Lenox Ave Ste 32, Jacksonville, FL 32205-6149 | 2019-01-09 |
| 1730650573 | Turnaround Retreat | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1159 E 13th St, Jacksonville, FL 32206-3105 | 2018-12-05 |
| 1962982090 | Joyful Care, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6500 Lake Gray Blvd Apt 322, Jacksonville, FL 32244-7553 | 2018-08-17 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 28540 |
Please comment or provide details below to improve the information on SPIRIT OF EXCELLENCE COMMUNITY OUTREACH, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.