Provider Demographics
NPI:1578719712
Name:MARTIN COUNTY RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:MARTIN COUNTY RESIDENTIAL SERVICES
Other - Org Name:MARTIN ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-792-8251
Mailing Address - Street 1:6003 W MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-9589
Mailing Address - Country:US
Mailing Address - Phone:252-792-8251
Mailing Address - Fax:252-792-5283
Practice Address - Street 1:6003 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892
Practice Address - Country:US
Practice Address - Phone:252-792-8251
Practice Address - Fax:252-792-5283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-058-002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health