Organization
RESIDENTIAL SERVICES AT REVERE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JACKIE J PARKER (DIRECTOR)
(919) 452-8903
Entity
Organization
Contact information
Practice address
516A REVERE RD, HILLSBOROUGH, NC 27278
(919) 241-4474
Mailing address
4511 NC HIGHWAY 86 N, HILLSBOROUGH, NC 27278-9250
(919) 452-8903
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
068151
NC
Other
Enumeration date
09/09/2011
Last updated
09/09/2011
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