Provider Demographics
NPI:1407071897
Name:RANDOLPH COMMUNITY SERVICES
Entity Type:Organization
Organization Name:RANDOLPH COMMUNITY SERVICES
Other - Org Name:REGIONAL CONSOLIDATED SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-629-5141
Mailing Address - Street 1:PO BOX 1883
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-1883
Mailing Address - Country:US
Mailing Address - Phone:336-629-5141
Mailing Address - Fax:336-629-1290
Practice Address - Street 1:221 S FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5724
Practice Address - Country:US
Practice Address - Phone:336-629-5141
Practice Address - Fax:336-629-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0130251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC945487226PMedicaid
NC947643382PMedicaid