Provider Demographics
NPI:1235276031
Name:UNITED RESIDENTIAL SERVICES OF N.C.
Entity Type:Organization
Organization Name:UNITED RESIDENTIAL SERVICES OF N.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-583-1104
Mailing Address - Street 1:PO BOX 25928
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5015
Mailing Address - Country:US
Mailing Address - Phone:910-583-1104
Mailing Address - Fax:910-630-1104
Practice Address - Street 1:6503 KEMPER CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2354
Practice Address - Country:US
Practice Address - Phone:910-583-1104
Practice Address - Fax:910-630-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC026-694320600000X
NC047-068320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418061Medicaid