NPIMap

Organization Active NPI

Residential & Support Services, Inc.

  • Case Management Agency
  • Charlotte, NC
National Provider Identifier
1417163643
Registry record updated Jun 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
RESIDENTIAL & SUPPORT SERVICES, INC.
Practice address
4425 Randolph Rd
Suite 400
Charlotte, NC 28211-2351
Phone
(704) 536-6661
Fax
(704) 536-0074
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2010

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

Authorized official

Name
Lori A Gougeon, BS
Title
Executive Director
Phone
(704) 536-6661

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary
Developmentally Disabled Services Day Training Agency 251C00000X

Addresses

Primary practice location

4425 Randolph Rd
Suite 400
Charlotte, NC 28211-2351

Mailing address

4425 Randolph Rd
Suite 400
Charlotte, NC 28211-2351
Phone (704) 536-6661

Other identifiers 1

IdentifierTypeStateIssuer
73735166OtherNCSUPERVISED LIVING PERIODI

National Provider Directory

National Provider Directory
Tax ID family
Inreach30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1417163643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351",
            "telephone_number": "704-536-6661",
            "fax_number": "704-536-0074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 RANDOLPH RD",
            "address_2": "SUITE 400",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112351",
            "telephone_number": "704-536-6661",
            "fax_number": "704-536-0074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTIAL & SUPPORT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "GOUGEON",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-536-6661",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUPERVISED LIVING PERIODI",
            "identifier": "73735166",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.