MEDICARE: CAROLINA RESIDENTIAL SERVICES, 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	251S00000X	Community/Behavioral Health Agency	MHL-096-005	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770626574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA RESIDENTIAL SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 286
Second Line	:
City	:	RUTHERFORD COLLEGE
State	:	NC
Zip	:	28671-0286
Country	:	US
Telephone Number	:	828-572-2333
Fax Number	:	980-525-0500

Provider Business Practice Location Address
First Line	:	1201 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2270
Country	:	US
Telephone Number	:	919-580-0020
Fax Number	:	919-580-0026

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. SUSAN M KINCAID
Credential	:
Telephone Number	:	828-572-2333

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/08/2016

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