NPIMap

Organization Active NPI

Residential Adolescent Adult Services and Training, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1760523344
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-092-503 Issued in NC
Legal business name
RESIDENTIAL ADOLESCENT ADULT SERVICES AND TRAINING, INC.
Practice address
4717 Windbreak LN
Raleigh, NC 27616-0740
Phone
(919) 862-0298
Fax
(919) 862-0299
NPI assigned
Feb 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Ignacio Roberto Kirk
Title
Ceo-Owner
Phone
(919) 696-6071

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-092-503 NC Primary

Addresses

Primary practice location

4717 Windbreak LN
Raleigh, NC 27616-0740

Mailing address

7301 Bassett Hall CT
Raleigh, NC 27616-5632
Phone (919) 431-0809

Other identifiers 1

IdentifierTypeStateIssuer
6604026MedicaidNC

Other names 1

  • Brooklyn's House Other name

National Provider Directory

National Provider Directory
Tax ID family
Handy's House9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760523344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 BASSETT HALL CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276165632",
            "telephone_number": "919-431-0809",
            "fax_number": "919-431-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4717 WINDBREAK LN",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276160740",
            "telephone_number": "919-862-0298",
            "fax_number": "919-862-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTIAL ADOLESCENT ADULT SERVICES AND TRAINING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIRK",
        "authorized_official_first_name": "IGNACIO",
        "authorized_official_middle_name": "ROBERTO",
        "authorized_official_title_or_position": "CEO-OWNER",
        "authorized_official_telephone_number": "919-696-6071",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-092-503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604026",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brooklyn's House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.