| Genext Life Llc | |
|
113 Vaquaro Dr Mooresville NC 28115-0236 | |
| (980) 705-1190 | |
| Not Available |
| Full Name | Genext Life Llc |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 113 Vaquaro Dr, Mooresville, North Carolina |
| Authorized Official Name and Position | Ecaroh Jackson (MANAGING MEMBER) |
| Authorized Official Contact | 4046424493 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genext Life Llc 1235 East Blvd Ste E Charlotte NC 28203-5876 Ph: (980) 705-1190 | Genext Life Llc 113 Vaquaro Dr Mooresville NC 28115-0236 Ph: (980) 705-1190 |
| NPI Number | 1295513299 |
|---|---|
| Provider Enumeration Date | 09/20/2023 |
| Last Update Date | 01/20/2024 |
| Certification Date | 01/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295513299 | NPI | - | NPPES |
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