Provider Demographics
NPI:1033359609
Name:SOUTHEASTERN RESIDENTIAL SERVICES OF NC
Entity Type:Organization
Organization Name:SOUTHEASTERN RESIDENTIAL SERVICES OF NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALANA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-850-3368
Mailing Address - Street 1:4811 RIVER STREAM WAY
Mailing Address - Street 2:204
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6583
Mailing Address - Country:US
Mailing Address - Phone:919-850-3368
Mailing Address - Fax:
Practice Address - Street 1:4811 RIVER STREAM WAY
Practice Address - Street 2:204
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6583
Practice Address - Country:US
Practice Address - Phone:919-850-3368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities