Healthcare Provider Details

I. General information

NPI: 1366639635
Provider Name (Legal Business Name): ROSINDALE FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CEMETERY RD
MAXTON NC
28364-2040
US

IV. Provider business mailing address

404 CEMETERY RD
MAXTON NC
28364-2040
US

V. Phone/Fax

Practice location:
  • Phone: 910-844-3715
  • Fax:
Mailing address:
  • Phone: 910-844-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMHL-078-198
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-078-198
License Number StateNC

VIII. Authorized Official

Name: MS. ADRIENNE BROWN
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 910-844-3715