Basic Information
| Provider Information | |||||||||
| NPI: | 1053450254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA RESIDENTIAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 BENSON RD | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275294648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196627873 | ||||||||
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| Practice Location | |||||||||
| Address1: | 247 COMMERCIAL CT NE | ||||||||
| Address2: | |||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286454451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287575710 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 9196627873 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | X | Agencies | Case Management | 251S00000X | X | Agencies | Community/Behavioral Health |
No ID Information.