Residential Services at Revere, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

068151 Issued in NC

Legal business name

RESIDENTIAL SERVICES AT REVERE, LLC

Practice address

516A Revere Rd
Hillsborough, NC 27278

Phone

(919) 241-4474

NPI assigned

Sep 9, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jackie J Parker

Title

Director

Phone

(919) 452-8903

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1003197609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 NC HIGHWAY 86 N",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "272789250",
            "telephone_number": "919-452-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516A REVERE RD",
            "city": "HILLSBOROUGH",
            "state": "NC",
            "postal_code": "27278",
            "telephone_number": "919-241-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTIAL SERVICES AT REVERE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "919-452-8903",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "068151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Hillsborough, NC
• Providers in Hillsborough, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.