Provider Demographics
NPI:1881771665
Name:UNION COUNTY RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:UNION COUNTY RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANALAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-283-1400
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0946
Mailing Address - Country:US
Mailing Address - Phone:704-283-1400
Mailing Address - Fax:704-283-7703
Practice Address - Street 1:2021 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174-8796
Practice Address - Country:US
Practice Address - Phone:704-624-6500
Practice Address - Fax:704-283-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-090-129320600000X
NCMHL-090-128320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804515Medicaid
NC7804516Medicaid
NC3408933Medicaid