Provider Demographics
NPI:1871683300
Name:RASS LLC
Entity Type:Organization
Organization Name:RASS LLC
Other - Org Name:DBA RESIDENTIAL & SUPPORTIVE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THOMASINA
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-293-4919
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-0586
Mailing Address - Country:US
Mailing Address - Phone:910-293-4919
Mailing Address - Fax:910-293-4533
Practice Address - Street 1:206 N FRONT ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-1833
Practice Address - Country:US
Practice Address - Phone:910-293-4919
Practice Address - Fax:910-293-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X, 172V00000X
NCMHL031021320600000X
NCMHL031018320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408706Medicaid
NC8301860Medicaid
NC8301239Medicaid
NC8301140Medicaid
NC8301140Medicaid