Provider Demographics
NPI:1902031222
Name:ADESS RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:ADESS RESIDENTIAL SERVICES, INC.
Other - Org Name:KESWICK PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-549-1580
Mailing Address - Street 1:2419 OLD TOWNE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-3439
Mailing Address - Country:US
Mailing Address - Phone:336-549-1580
Mailing Address - Fax:336-282-6911
Practice Address - Street 1:3705 ROCK HAVEN DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3714
Practice Address - Country:US
Practice Address - Phone:336-286-0036
Practice Address - Fax:336-282-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children