Provider Demographics
NPI:1740325349
Name:CORPUS CHRISTI SERVICES, INC.
Entity type:Organization
Organization Name:CORPUS CHRISTI SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCRAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-735-2988
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-0640
Mailing Address - Country:US
Mailing Address - Phone:910-735-2988
Mailing Address - Fax:910-735-2987
Practice Address - Street 1:20 ACADIANA DR
Practice Address - Street 2:
Practice Address - City:PARKTON
Practice Address - State:NC
Practice Address - Zip Code:28371-9050
Practice Address - Country:US
Practice Address - Phone:910-858-1629
Practice Address - Fax:910-858-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL078147322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603610Medicaid