NPIMap

Organization Active NPI

Carolina Residential Services, Inc

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Swansboro, NC
National Provider Identifier
1497898183
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-067-103 Issued in NC
Legal business name
CAROLINA RESIDENTIAL SERVICES, INC
Practice address
413 Glancy St
Swansboro, NC 28584-9656
Phone
(910) 325-0740
Fax
(910) 325-0740
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
Community/Behavioral Health Agency 251S00000X
Adult Care Home Facility 311ZA0620X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X MHL-067-103 NC Primary

Addresses

Primary practice location

413 Glancy St
Swansboro, NC 28584-9656

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
7804290MedicaidNC
7806610MedicaidNC

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

Locations

413 S Glancy St
Swansboro, NC 28584
Phone (252) 503-1879

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": "1497898183",
    "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": "413 GLANCY ST",
            "city": "SWANSBORO",
            "state": "NC",
            "postal_code": "285849656",
            "telephone_number": "910-325-0740",
            "fax_number": "910-325-0740"
        }
    ],
    "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-067-103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804290",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7806610",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Swansboro, 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.