MEDICARE: CAROLINA RESIDENTIAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MHL-026-837	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124393962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA RESIDENTIAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 286
Second Line	:
City	:	RUTHERFORD COLLEGE
State	:	NC
Zip	:	28671-0286
Country	:	US
Telephone Number	:	828-572-2333
Fax Number	:	980-225-0500

Provider Business Practice Location Address
First Line	:	1014 HAY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5316
Country	:	US
Telephone Number	:	910-920-2891
Fax Number	:	910-920-2756

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	SUSAN M KINCAID
Credential	:
Telephone Number	:	828-413-3786

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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Directions to “CAROLINA RESIDENTIAL SERVICES ” Practice Location

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