Provider Demographics
NPI:1144422452
Name:ROSE'S CASTLE RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:ROSE'S CASTLE RESIDENTIAL SERVICES, INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALONZO
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-680-4637
Mailing Address - Street 1:505 COOK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1152
Mailing Address - Country:US
Mailing Address - Phone:919-680-4637
Mailing Address - Fax:919-680-4637
Practice Address - Street 1:505 COOK RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1152
Practice Address - Country:US
Practice Address - Phone:919-680-4637
Practice Address - Fax:919-680-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL032371320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805584Medicaid