Provider Demographics
NPI:1184945693
Name:RESIDENTIAL ADOLESCENT ADULT SEERVICES & TRAINING, INC.
Entity type:Organization
Organization Name:RESIDENTIAL ADOLESCENT ADULT SEERVICES & TRAINING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNEER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-329-2630
Mailing Address - Street 1:304 W. MILLBROOK RD.
Mailing Address - Street 2:STE. F.
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4373
Mailing Address - Country:US
Mailing Address - Phone:919-329-2630
Mailing Address - Fax:919-329-2631
Practice Address - Street 1:304 W. MILLBROOK RD.
Practice Address - Street 2:STE. F.
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4373
Practice Address - Country:US
Practice Address - Phone:919-329-2630
Practice Address - Fax:919-329-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL092-503251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908441Medicaid