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	320800000X	Mental Illness Community Based Residential Treatment Facility	MHL 031063	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	:	1770705956
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	:	980-225-0500

Provider Business Practice Location Address
First Line	:	314 EAST WESTBROOK STREET
Second Line	:
City	:	WALLACE
State	:	NC
Zip	:	28466-1533
Country	:	US
Telephone Number	:	910-285-5319
Fax Number	:	910-285-5438

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/12/2013

Similar Medicare Providers

1235330002 — CAROLINA RESIDENTIAL SERVICES, INC.
Practice Location Address:

314 EAST WESTBROOK STREET
WALLACE, NC
28466-1533

Practice Phone: 910-285-5319
Practice Fax: 910-285-5438

1891637153 — MRS. SARAH ELIZABETH DORSEY FNP-C
Practice Location Address:

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WALLACE, NC
28466-9201

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Practice Fax:

1144226374 — MARY A FRANKOS M.D.
Practice Location Address:

112 MEDICAL VILLAGE DR , UNIT F
WALLACE, NC
28466-9999

Practice Phone: 910-285-0333
Practice Fax: 910-285-0336

1528067519 — DR. DANIEL MICHAEL RICCI M.D.
Practice Location Address:

207 E MURPHY ST
WALLACE, NC
28466-1946

Practice Phone: 910-285-4100
Practice Fax: 910-285-4766

1689673618 — DANIEL M RICCI M.D. P.A.
Practice Location Address:

207 E MURPHY ST
WALLACE, NC
28466-1946

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1295737963 — KERN LEE BARROW PA
Practice Location Address:

112 MEDICAL VILLAGE DR , SUITE G
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28466-1665

Practice Phone: 910-285-0333
Practice Fax: 910-285-0336

Directions to “CAROLINA RESIDENTIAL SERVICES, INC. ” Practice Location

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