Organization
CAROLINA RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEREK WILSON (DIRECTOR OF OPERATIONS)
(919) 662-7873
Entity
Organization
Contact information
Practice address
1691 OLD BUFFALO FORD RD, ASHEBORO, NC 27205-7893
(336) 633-4255
(336) 633-4255
Mailing address
1202 BENSON RD, GARNER, NC 27529-4648
(919) 662-7873
(919) 662-7879
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-076-056
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804135
—
NC
Enumeration date
02/14/2007
Last updated
08/22/2020
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