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General NPI Number Information
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NPI Number | 1740591684
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Entity Type | Organization
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Legal Business Name | KIDS' RESIDENTIAL SERVICES, INC.
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 114 GREENHOUSE LN
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-3140
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Country | US
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Telephone | 910-496-0661
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Fax | 910-829-0088
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | FAYETTEVILLE
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State | NC
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Zip | 28302-0429
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Country | US
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Telephone | 910-829-7184
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Fax | 910-829-0088
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | MISS BRITTANY MARIE COOPER
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Credential | C.H.E.S.
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Telephone | 910-829-7184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MHL-063-017
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License Number State | NC
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