Provider Demographics
NPI:1619110665
Name:CRSE ADVANCED PLACEMENT HOMES, INC.
Entity Type:Organization
Organization Name:CRSE ADVANCED PLACEMENT HOMES, INC.
Other - Org Name:KINGSTREE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-287-8764
Mailing Address - Street 1:2295 E 14TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-6804
Mailing Address - Country:US
Mailing Address - Phone:336-287-8764
Mailing Address - Fax:336-377-3337
Practice Address - Street 1:1005 KINGSTREE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-4940
Practice Address - Country:US
Practice Address - Phone:336-287-8764
Practice Address - Fax:336-377-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children