Provider Demographics
NPI:1518634617
Name:RESIDENCE CARE SERVICE LLC
Entity Type:Organization
Organization Name:RESIDENCE CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:347-546-4877
Mailing Address - Street 1:1815 LAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755
Mailing Address - Country:US
Mailing Address - Phone:347-546-4877
Mailing Address - Fax:
Practice Address - Street 1:909 N SALISBURY AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:NC
Practice Address - Zip Code:28159-1828
Practice Address - Country:US
Practice Address - Phone:347-546-4877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCUNAVAILABLEMedicaid