Provider Demographics
NPI: | 1710398961 |
---|---|
Name: | TOUCHSTONE RESIDENTIAL SERVICE |
Entity Type: | Organization |
Organization Name: | TOUCHSTONE RESIDENTIAL SERVICE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JEFFREY |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | JENKINS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 919-465-3277 |
Mailing Address - Street 1: | 1224 COPELAND OAKS DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MORRISVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27560-6614 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-465-3277 |
Mailing Address - Fax: | 919-465-3222 |
Practice Address - Street 1: | 4833 TOLLEY CT |
Practice Address - Street 2: | |
Practice Address - City: | RALEIGH |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27616-7827 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-303-4316 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-09 |
Last Update Date: | 2014-05-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 3409544 | Medicaid |