NPIMap

Organization Active NPI

Carolina Residential Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Statesville, NC
National Provider Identifier
1265575971
Registry record updated Jul 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
MHL-049-063 Issued in NC
Legal business name
CAROLINA RESIDENTIAL SERVICES, INC
Practice address
804 Hunter St
Statesville, NC 28677-3530
Phone
(704) 883-0850
Fax
(704) 873-9502
NPI assigned
Feb 14, 2007
Last updated
Jul 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2013

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

Authorized official

Name
Ms. Susan M Kincaid
Title
Director
Phone
(828) 572-2333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Care Home Facility 311ZA0620X NU
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X MHL-049-063 NC Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

804 Hunter St
Statesville, NC 28677-3530

Mailing address

PO Box 286
Rutherford College, NC 28671-0286
Phone (828) 572-2333

Other identifiers 2

IdentifierTypeStateIssuer
7806597MedicaidNC
7803401MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Carolina Residential Services Inc42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374278400000",
    "number": "1265575971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 286",
            "city": "RUTHERFORD COLLEGE",
            "state": "NC",
            "postal_code": "286710286",
            "telephone_number": "828-572-2333",
            "fax_number": "980-225-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 HUNTER ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773530",
            "telephone_number": "704-883-0850",
            "fax_number": "704-873-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2013-07-20",
        "status": "A",
        "authorized_official_last_name": "KINCAID",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "828-572-2333",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-049-063",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806597",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803401",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2013; 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.