Organization
CLASSIQUE RESIDENTIAL SERVICES-LLC
Active
Organization
CLASSIQUE RESIDENTIAL SERVICES-LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY AUGUSTUS LUTTERODT MS (EXECUTIVE DIRECTOR)
(336) 510-6966
Entity
Organization
Contact information
Practice address
340 BURLINGATE DR APT E, GREENSBORO, NC 27407-1295
(336) 510-6966
Mailing address
340 BURLINGATE DR APT E, GREENSBORO, NC 27407-1295
(336) 510-6966
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
NC
Other
Enumeration date
10/27/2007
Last updated
10/27/2007
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