MEDICARE: RESIDENTIAL AND FAMILY SERVICES, LLC.

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

General Provider Information

NPI Number	:	1801572904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL AND FAMILY SERVICES, LLC.

Provider Business Mailing Address
First Line	:	3020 PROSPERITY CHURCH RD -I
Second Line	:	B0X 226
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-8100
Country	:	US
Telephone Number	:	704-777-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 E INDEPENDENCE BLVD STE 260
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-9499
Country	:	US
Telephone Number	:	704-777-5100
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	CRYSTAL B WALKER
Credential	:
Telephone Number	:	704-777-5100

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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