Healthcare Provider Details

I. General information

NPI: 1245493931
Provider Name (Legal Business Name): RESIDENTIAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 EPHESUS CHURCH RD
CHAPEL HILL NC
27517-2551
US

IV. Provider business mailing address

111 PROVIDENCE RD
CHAPEL HILL NC
27514-2229
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-7391
  • Fax:
Mailing address:
  • Phone: 919-942-7391
  • Fax: 919-933-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DENNIS BRADSHAW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-942-7391