Provider Demographics
NPI:1205038080
Name:R.J. WHITSETT RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:R.J. WHITSETT RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:WHITSETT
Authorized Official - Last Name:CRITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-215-5900
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-0482
Mailing Address - Country:US
Mailing Address - Phone:336-215-5900
Mailing Address - Fax:336-656-9203
Practice Address - Street 1:1210 FOXHAVEN DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8340
Practice Address - Country:US
Practice Address - Phone:336-215-5900
Practice Address - Fax:336-656-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-653322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603813Medicaid