Organization
ETTA'S RESIDENTIAL SERVICES AND SUPPORTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEON C ROGERS CEO (CEO)
(919) 599-1636
Entity
Organization
Contact information
Practice address
4833 TOLLEY CT, RALEIGH, NC 27616-7827
(919) 599-1636
(919) 720-4818
Mailing address
4833 TOLLEY CT, RALEIGH, NC 27616-7827
(919) 599-1636
(919) 720-4818
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-092-705
NC
Other
Enumeration date
03/27/2008
Last updated
03/27/2008
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