Provider Demographics
NPI:1447393277
Name:CAROLINA RESIDENTIAL SERVICES, INC
Entity Type:Organization
Organization Name:CAROLINA RESIDENTIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-572-2333
Mailing Address - Street 1:2037 CONNELLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-7830
Mailing Address - Country:US
Mailing Address - Phone:828-572-2333
Mailing Address - Fax:980-225-0500
Practice Address - Street 1:933 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-2366
Practice Address - Country:US
Practice Address - Phone:828-632-0790
Practice Address - Fax:828-635-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-002-008251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301037SMedicaid
NC8303432SMedicaid