MEDICARE: CRSE ADVANCED PLACEMENT HOMES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1619110665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRSE ADVANCED PLACEMENT HOMES, INC.

Provider Business Mailing Address
First Line	:	2295 E 14TH ST
Second Line	:	SUITE 400
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-6804
Country	:	US
Telephone Number	:	336-287-8764
Fax Number	:	336-377-3337

Provider Business Practice Location Address
First Line	:	1005 KINGSTREE RIDGE DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-4940
Country	:	US
Telephone Number	:	336-287-8764
Fax Number	:	336-377-3337

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	MR. CHRISTOPHER R STEWART
Credential	:
Telephone Number	:	336-287-8764

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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