Organization
CAROLINA RESIDENTIAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN M KINCAID (DIRECTOR)
(828) 572-2333
Entity
Organization
Contact information
Practice address
314 EAST WESTBROOK STREET, WALLACE, NC 28466-1533
(910) 285-5319
(910) 285-5438
Mailing address
PO BOX 286, RUTHERFORD COLLEGE, NC 28671-0286
(828) 572-2333
(980) 225-0500
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL 031063
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805778
—
NC
05
—
7806594
—
NC
Enumeration date
05/03/2007
Last updated
06/12/2013
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