MARY L MCCULLERS-JACKSON (NPI# 1912021486) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912021486 |
| Entity Type | Organization |
| Organization Name | MARY L MCCULLERS-JACKSON |
| Practice Address |
501 Bunn St Zebulon NC 27597-9177 |
| Mailing Address |
5641 Quail Covey Lane Wendell NC 27591-7901 |
| Practice Telephone | 9192693060 |
| Practice Fax Number | 9192667901 |
| Mailing Telephone | 9192665291 |
| Mailing Fax Number | 9192667901 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-06-26 |
| NPI Deactivation Date | 06/03/2008 |
| NPI Reactivation Date | 2008-06-19 |
| Authorized Official Name | MS. MARY LILLY MCCULLERS JACKSON (OWNER ADMINISTRATOR) |
| Authorized Official Telephone | 9192665291 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
MHL092516 | NC | Nursing & Custodial Care Facilities |
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL 092 516 | NC | Residential Treatment Facilities |
| Street Address |
501 BUNN ST |
| City | ZEBULON |
| State | NC |
| Zip Code | 27597-9177 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306457668 | Tiffani Morson | Massage Therapist | 15055 Nc 96, Zebulon, NC 27597 | 2020-08-11 |
| 1639692775 | Katherine Skinner | Counselor | 21 Carlyle Rd., Zebulon, NC 27597 | 2017-07-20 |
| 1851703821 | Kimberly Griswold | Pharmacist | 2021 Wynnscott Farm Lane, Zebulon, NC 27597 | 2014-05-27 |
| 1770922502 | Thompson Home | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1701 West Gannon Avenue, Zebulon, NC 27597 | 2013-06-14 |
| 1780924266 | Jones Outreach Services,llp | Counselor | 700b Pony Road, Zebulon, NC 27597 | 2013-02-21 |
| 1053692806 | Allcare Health Source L.L.C. | Home Health | 806 Arendale, B, Zebulon, NC 27597 | 2011-09-07 |
| 1700104171 | Clearly Speaking, Inc. | Speech-Language Pathologist | 9100 Ashton Glen Dr, Zebulon, NC 27597 | 2010-05-11 |
| 1497975817 | Connie Mullins | Nurse Practitioner | 1002 Dogwood Drive, Zebulon, NC 27597 | 2007-04-26 |
| 1073730370 | Amanda Cottle Kapl | Speech-Language Pathologist | 13270 Brantley Woods Rd, Zebulon, NC 27597 | 2007-04-19 |
| 1578780169 | Heber W. Windley IIi, D.d.s.,m.s.,p.a. | Dentist | 315 Hospital Road, Zebulon, NC 27597 | 2007-04-18 |
| Find all providers in zip 27597 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518180769 | Carolina Center for Advanced Care | Community Based Residential Treatment Facility, Mental Illness | 10412 Perry Ridge Ct, Zebulon, NC 27597-6843 | 2007-04-10 |
| 1093850620 | Jag's Developmental Disability Adult Care | Community Based Residential Treatment Facility, Mental Illness | 1006 Laurel Leaf Rd, 1005 Laurel Leaf Road, Zebulon, NC 27597-6715 | 2007-02-21 |
| 1689720476 | Jackson Family Care | Community Based Residential Treatment Facility, Mental Illness | 221 E Barbee St, Zebulon, NC 27597-2811 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366041667 | Jalisa Jackson | Community Based Residential Treatment Facility, Mental Illness | 11413 Mangla Dr, Charlotte, NC 28214-8885 | 2020-10-19 |
| 1245837061 | Bliss Haven Group LLC | Community Based Residential Treatment Facility, Mental Illness | 2442 Sandhurst Ct, Gastonia, NC 28054-2738 | 2020-10-05 |
| 1386259265 | Nevaehs Caring Hands | Community Based Residential Treatment Facility, Mental Illness | 2509 Dalton Rd, Rocky Mount, NC 27803-4721 | 2020-09-09 |
| 1588279442 | C & C Homecare, LLC | Community Based Residential Treatment Facility, Mental Illness | 5119 Holdens Cross Rd, Wilson, NC 27893-8253 | 2020-09-08 |
| 1801409859 | Destiny & Miracle LLC | Community Based Residential Treatment Facility, Mental Illness | 1024 Houston St, Gastonia, NC 28052-1632 | 2020-08-28 |
| 1699329433 | Fresh Start Today Inc | Community Based Residential Treatment Facility, Mental Illness | 3707 Roseheim Ct, Greensboro, NC 27405-4867 | 2019-07-30 |
| 1003460833 | Care-in-full | Community Based Residential Treatment Facility, Mental Illness | 1338 Sharp Ridge Rd, Greensboro, NC 27406-8597 | 2019-07-30 |
| 1366001976 | Foundation of Hope, Inc. | Community Based Residential Treatment Facility, Mental Illness | 119 Grice Road, Chadbourn, NC 28431-6709 | 2019-06-07 |
| 1558927590 | Tall Family Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1915 Hasty Rd, Marshville, NC 28103-0029 | 2019-05-15 |
| 1174187868 | Stepping Stone Services Inc. | Community Based Residential Treatment Facility, Mental Illness | 2720 White Oak Ln, Kannapolis, NC 28083-7256 | 2019-04-28 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MARY L MCCULLERS-JACKSON.
| 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.