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General NPI Number Information
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NPI Number | 1942333240
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Entity Type | Organization
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Legal Business Name | SPIRIT OF EXCELLENCE COMMUNITY OUTREACH,INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 123 HENDERSON DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5601
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Country | US
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Telephone | 910-939-4663
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Fax | 910-939-5079
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Provider Business Mailing Address
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Address Line | PO BOX 752
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City | JACKSONVILLE
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State | NC
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Zip | 28541-0752
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Country | US
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Telephone | 910-939-4663
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Fax | 910-939-5079
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Authorized Official
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Title or Position | CEO
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Name | MRS. HELEN DELORISE FLUDD
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Credential |
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Telephone | 910-382-6595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | MHL-067-164
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License Number State | NC
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Taxonomy #8
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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