MEDICARE: 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	315P00000X	Intellectual Disabilities Intermediate Care Facility

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

General Provider Information

NPI Number	:	1780739045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESIDENTIAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	111 PROVIDENCE RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-2229
Country	:	US
Telephone Number	:	919-942-7391
Fax Number	:	919-933-4490

Provider Business Practice Location Address
First Line	:	802 CHRISTOPHER RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-4025
Country	:	US
Telephone Number	:	919-929-0732
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DENNIS BRADSHAW
Credential	:
Telephone Number	:	919-942-7391

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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Directions to “RESIDENTIAL SERVICES, INC. ” Practice Location

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