Provider Demographics
NPI:1275678690
Name:RESIDENTIAL TREATMENT SERVICES
Entity Type:Organization
Organization Name:RESIDENTIAL TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-227-2994
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-0427
Mailing Address - Country:US
Mailing Address - Phone:336-227-2994
Mailing Address - Fax:336-227-2994
Practice Address - Street 1:136 HALL AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2310
Practice Address - Country:US
Practice Address - Phone:336-227-2994
Practice Address - Fax:336-227-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-016324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301474Medicaid
NC7804821Medicaid
NC7803872Medicaid