Provider Demographics
NPI:1417562562
Name:RESIDENTIAL ADOLESCENT COMMUNITY SERVICES INC.
Entity Type:Organization
Organization Name:RESIDENTIAL ADOLESCENT COMMUNITY SERVICES INC.
Other - Org Name:RESIDENTIAL ADOLESCENT COMMUNITY SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-890-0666
Mailing Address - Street 1:443 N. SUMMIT AVE
Mailing Address - Street 2:CHARLOTTE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-3320
Mailing Address - Country:US
Mailing Address - Phone:980-938-4354
Mailing Address - Fax:
Practice Address - Street 1:443 N. SUMMIT AVE
Practice Address - Street 2:CHARLOTTE
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2821
Practice Address - Country:US
Practice Address - Phone:980-938-4354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness