Healthcare Provider Details

I. General information

NPI: 1306764147
Provider Name (Legal Business Name): KINDNEST RESIDENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4008 MITCHELL MILL RD STE 104
RALEIGH NC
27616-8895
US

IV. Provider business mailing address

4008 MITCHELL MILL RD STE 104
RALEIGH NC
27616-8895
US

V. Phone/Fax

Practice location:
  • Phone: 984-383-3769
  • Fax:
Mailing address:
  • Phone: 984-383-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ARRIELLE UPCHURCH
Title or Position: OWNER
Credential:
Phone: 984-383-3769