Provider Demographics
NPI:1912106873
Name:EMMANUEL RESIDENTIAL & BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:EMMANUEL RESIDENTIAL & BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-752-6353
Mailing Address - Street 1:2927 LANDING CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GRIMESLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27837-9512
Mailing Address - Country:US
Mailing Address - Phone:252-752-6353
Mailing Address - Fax:252-355-4337
Practice Address - Street 1:113 W FIRETOWER RD STE K
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8414
Practice Address - Country:US
Practice Address - Phone:252-756-4666
Practice Address - Fax:252-355-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health