Provider Demographics
NPI:1265674113
Name:MTS THERAPEUTIC RESIDENTIAL SERVICES, LLC
Entity Type:Organization
Organization Name:MTS THERAPEUTIC RESIDENTIAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHASITY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HUDSON-ODOI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-938-0670
Mailing Address - Street 1:303 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5647
Mailing Address - Country:US
Mailing Address - Phone:910-938-0670
Mailing Address - Fax:910-938-1229
Practice Address - Street 1:303 S SHORE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-5647
Practice Address - Country:US
Practice Address - Phone:910-938-0670
Practice Address - Fax:910-938-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care