Provider Demographics
NPI:1902045941
Name:NC RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:NC RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-253-0318
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-0446
Mailing Address - Country:US
Mailing Address - Phone:336-510-7464
Mailing Address - Fax:336-510-7985
Practice Address - Street 1:3314 WILITON WAY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5983
Practice Address - Country:US
Practice Address - Phone:336-510-7464
Practice Address - Fax:336-510-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health