MEDICARE: CAROLINA RESIDENTIAL SERVICES, INC.

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235330002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1202 BENSON RD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-4648
Country	:	US
Telephone Number	:	919-662-7731
Fax Number	:	919-662-7879

Provider Business Practice Location Address
First Line	:	314 EAST WESTBROOK STREET
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1533
Country	:	US
Telephone Number	:	910-285-5319
Fax Number	:	910-285-5438

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	DEREK WILSON
Credential	:
Telephone Number	:	919-662-7731

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	09/11/2025

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