Provider Demographics
NPI:1861677346
Name:LILLIES RESIDENTIAL SERVICE'S
Entity Type:Organization
Organization Name:LILLIES RESIDENTIAL SERVICE'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILLIE
Authorized Official - Middle Name:DORINE
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-353-2746
Mailing Address - Street 1:3413 EVERS AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-8519
Mailing Address - Country:US
Mailing Address - Phone:919-353-2746
Mailing Address - Fax:919-258-9830
Practice Address - Street 1:2168 LAKEWOOD FALLS RD
Practice Address - Street 2:
Practice Address - City:GOLDSTON
Practice Address - State:NC
Practice Address - Zip Code:27252-8916
Practice Address - Country:US
Practice Address - Phone:919-353-2746
Practice Address - Fax:919-258-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness