Healthcare Provider Details

I. General information

NPI: 1225170343
Provider Name (Legal Business Name): YANCEY RESIDENTIAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CELO ST
BURNSVILLE NC
28714-3008
US

IV. Provider business mailing address

35 CELO ST
BURNSVILLE NC
28714-3008
US

V. Phone/Fax

Practice location:
  • Phone: 828-682-4944
  • Fax: 828-682-9813
Mailing address:
  • Phone: 828-682-4944
  • Fax: 828-682-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberMHL 100-014
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL 100-013
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL 100-009
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHL 100-014
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMH 100-009
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberMHL 100-013
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL 100-013
License Number StateNC
# 8
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL 100-014
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL 100-009
License Number StateNC

VIII. Authorized Official

Name: MS. DOROTHY P. STYLES
Title or Position: EXECUTIVE DIRECTOR
Credential: QDDP
Phone: 828-682-4944