Organization
RESIDENTIAL & SUPPORT SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI A GOUGEON BS (EXECUTIVE DIRECTOR)
(704) 536-6661
Entity
Organization
Contact information
Practice address
4425 RANDOLPH RD, SUITE 400, CHARLOTTE, NC 28211-2351
(704) 536-6661
(704) 536-0074
Mailing address
4425 RANDOLPH RD, SUITE 400, CHARLOTTE, NC 28211-2351
(704) 536-6661
(704) 536-0074
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73735166
SUPERVISED LIVING PERIODI
NC
Enumeration date
05/15/2007
Last updated
06/08/2010
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