Etta'S Residential Services and Supports, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

MHL-092-705 Issued in NC

Legal business name

ETTA'S RESIDENTIAL SERVICES AND SUPPORTS, INC.

Practice address

4833 Tolley CT
Raleigh, NC 27616-7827

Phone

(919) 599-1636

Fax

(919) 720-4818

NPI assigned

Mar 27, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Leon C Rogers, CEO

Title

Ceo

Phone

(919) 599-1636

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1206576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1206576000000",
    "number": "1932371135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4833 TOLLEY CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276167827",
            "telephone_number": "919-599-1636",
            "fax_number": "919-720-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4833 TOLLEY CT",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276167827",
            "telephone_number": "919-599-1636",
            "fax_number": "919-720-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETTA'S RESIDENTIAL SERVICES AND SUPPORTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-27",
        "last_updated": "2008-03-27",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "LEON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "919-599-1636",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "MHL-092-705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amelia Etheridge
• William Thomas Gordon Etheridge
• Erica Etienne
• Nicanor Etienne
• Stefanie Linette Etienne, MD
• Halima Ettalbi
• Carly Nassereh Ettefagh, MSOT, OTR/L
• Holly Lucas Eubanks, NP
• Kristen Ashley Eubanks
• Tyler Steven Eubanks, PT, DPT

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; 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.