Provider Demographics
NPI:1770616518
Name:RESIDENTIAL ADOLESCENT ADULT SERVICES AND INC.
Entity type:Organization
Organization Name:RESIDENTIAL ADOLESCENT ADULT SERVICES AND INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-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:919-696-6071
Mailing Address - Street 1:304 W. MILLBROOK RD. STE. F.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4381
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:27609-4381
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:2007-03-13
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health