Provider Demographics
NPI:1629123856
Name:ST. MICHAEL'S RESIDENTIAL & COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:ST. MICHAEL'S RESIDENTIAL & COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:704-466-0046
Mailing Address - Street 1:6630 FAIR LAWN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-3720
Mailing Address - Country:US
Mailing Address - Phone:704-537-3297
Mailing Address - Fax:704-434-0268
Practice Address - Street 1:6630 FAIR LAWN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-3720
Practice Address - Country:US
Practice Address - Phone:704-537-3297
Practice Address - Fax:704-434-0268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-060-1006322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children