Organization
SURRY-YADKIN RESIDENTIAL SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA DENNY (EXECUTIVE DIRECTOR/QIDP)
(336) 719-0062
Entity
Organization
Contact information
Practice address
134 SYDNOR ST, MOUNT AIRY, NC 27030
(336) 789-3451
Mailing address
401 S MAIN ST, SUITE 100, MOUNT AIRY, NC 27030-4717
(336) 719-0062
(336) 719-0064
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
MHL-086-019
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340608M
—
NC
Enumeration date
08/21/2006
Last updated
06/08/2018
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