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General NPI Number Information
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NPI Number | 1770124067
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Entity Type | Organization
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Legal Business Name | CONTINUUM RESIDENTIAL SERVICES, LLC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 34295 DAYBREAK DR
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City | CALLAHAN
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State | FL
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Zip | 32011-3277
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Country | US
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Telephone | 864-871-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 34295 DAYBREAK DR
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City | CALLAHAN
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State | FL
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Zip | 32011-3277
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Country | US
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Telephone | 864-871-0406
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MARYJO NABORS
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Credential |
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Telephone | 864-871-0406
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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