Organization
CAROLINA RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN M KINCAID (DIRECTOR)
(828) 572-2333
Entity
Organization
Contact information
Practice address
804 HUNTER ST, STATESVILLE, NC 28677-3530
(704) 883-0850
(704) 873-9502
Mailing address
PO BOX 286, RUTHERFORD COLLEGE, NC 28671-0286
(828) 572-2333
(980) 225-0500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
311ZA0620X
Adult Care Home Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-049-063
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803401
—
NC
05
—
7806597
—
NC
Enumeration date
02/14/2007
Last updated
07/20/2013
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