Provider Demographics
NPI:1720420177
Name:RESOURCES FOR SENIORS, INC
Entity Type:Organization
Organization Name:RESOURCES FOR SENIORS, INC
Other - Org Name:DEPARTURE DRIVE TOTAL LIFE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTENGIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-713-1521
Mailing Address - Street 1:1110 NAVAHO DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7352
Mailing Address - Country:US
Mailing Address - Phone:919-872-7933
Mailing Address - Fax:
Practice Address - Street 1:5124 DEPARTURE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-1958
Practice Address - Country:US
Practice Address - Phone:919-873-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408008Medicaid