Provider Demographics
NPI:1235330002
Name:CAROLINA RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:CAROLINA RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-662-7731
Mailing Address - Street 1:1202 BENSON RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4648
Mailing Address - Country:US
Mailing Address - Phone:919-662-7731
Mailing Address - Fax:919-662-7879
Practice Address - Street 1:314 EAST WESTBROOK STREET
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1533
Practice Address - Country:US
Practice Address - Phone:910-285-5319
Practice Address - Fax:910-285-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health