Organization
RESIDENTIAL SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MURRAY (EXECUTIVE ASSISTANT)
(919) 787-1214
Entity
Organization
Contact information
Practice address
3416 ATLANTIC AVE, RALEIGH, NC 27604-1643
(919) 787-1214
(919) 787-3416
Mailing address
PO BOX 98476, RALEIGH, NC 27624-8476
(919) 787-1214
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-092-474
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418153
—
NC
05
—
7804508
—
NC
05
—
7804509
—
NC
05
—
7804510
—
NC
05
—
8300856
—
NC
05
—
8300856B
—
NC
05
—
8702203
—
NC
Enumeration date
07/30/2013
Last updated
07/30/2013
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