Provider Demographics
NPI:1225358427
Name:KIDS' RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:KIDS' RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CHES
Authorized Official - Phone:910-829-7184
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28302-0429
Mailing Address - Country:US
Mailing Address - Phone:910-829-7184
Mailing Address - Fax:910-829-0088
Practice Address - Street 1:1112 DEVONSHIRE TRL
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-3910
Practice Address - Country:US
Practice Address - Phone:910-944-1047
Practice Address - Fax:910-829-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-063-016251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health