NPIMap

Organization Active NPI

Carolina Residential Services, Inc

  • Community/Behavioral Health Agency
  • Goldsboro, NC
National Provider Identifier
1770626574
Registry record updated Aug 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
MHL-096-005 Issued in NC
Legal business name
CAROLINA RESIDENTIAL SERVICES, INC
Practice address
1201 Wayne Memorial Dr
Goldsboro, NC 27534-2270
Phone
(919) 580-0020
Fax
(919) 580-0026
NPI assigned
Feb 14, 2007
Last updated
Aug 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2016

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X MHL-096-005 NC Primary

Addresses

Primary practice location

1201 Wayne Memorial Dr
Goldsboro, NC 27534-2270

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
8301224SMedicaidNC
8303429SMedicaidNC

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

1201 Wayne Memorial Dr
Goldsboro, NC 27534
Phone (919) 580-0020

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": "1470614400000",
    "number": "1770626574",
    "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": "980-525-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342270",
            "telephone_number": "919-580-0020",
            "fax_number": "919-580-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA RESIDENTIAL SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2016-08-08",
        "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": "NC",
            "license": "MHL-096-005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8301224S",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8303429S",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; 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.