Healthcare Provider Details

I. General information

NPI: 1871683300
Provider Name (Legal Business Name): RASS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N FRONT ST
WARSAW NC
28398-1833
US

IV. Provider business mailing address

PO BOX 586
WARSAW NC
28398-0586
US

V. Phone/Fax

Practice location:
  • Phone: 910-293-4919
  • Fax: 910-293-4533
Mailing address:
  • Phone: 910-293-4919
  • Fax: 910-293-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberMHL031021
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL031018
License Number StateNC

VIII. Authorized Official

Name: MRS. THOMASINA W WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-293-4919