Provider Demographics
NPI:1235543802
Name:RIKARDS RESIDENTIAL FAMILY CARE
Entity Type:Organization
Organization Name:RIKARDS RESIDENTIAL FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:RIKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-772-2491
Mailing Address - Street 1:1628 DUNBAR ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-3806
Mailing Address - Country:US
Mailing Address - Phone:336-772-2491
Mailing Address - Fax:336-373-3962
Practice Address - Street 1:1628 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-3806
Practice Address - Country:US
Practice Address - Phone:336-772-2491
Practice Address - Fax:336-373-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health