Healthcare Provider Details

I. General information

NPI: 1497898159
Provider Name (Legal Business Name): CAROLINA RESIDENTIAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W CAMDEN ST
WINDSOR NC
27983-1828
US

IV. Provider business mailing address

PO BOX 286
RUTHERFORD COLLEGE NC
28671-0286
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-6544
  • Fax: 252-794-6544
Mailing address:
  • Phone: 828-572-2333
  • Fax: 980-225-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberMHL-008-002
License Number StateNC

VIII. Authorized Official

Name: MS. SUSAN M KINCAID
Title or Position: DIRECTOR
Credential:
Phone: 828-572-2333