Provider Demographics
NPI:1255578530
Name:RESIDENT CARE SERVICES, INC.
Entity type:Organization
Organization Name:RESIDENT CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT , CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBILIBOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:770-319-1062
Mailing Address - Street 1:513 TWO IRON WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5035
Mailing Address - Country:US
Mailing Address - Phone:404-806-6770
Mailing Address - Fax:720-834-9025
Practice Address - Street 1:513 TWO IRON WAY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5035
Practice Address - Country:US
Practice Address - Phone:404-806-6770
Practice Address - Fax:720-834-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176541311Z00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility