Ridge Street Youth Services, Inc

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

MHL-031-068 Issued in NC

Legal business name

RIDGE STREET YOUTH SERVICES, INC

Practice address

103 Ash Street
Rose Hill, NC 28458

Phone

(910) 289-2422

Fax

(910) 289-2734

NPI assigned

Feb 12, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Alfred Dixon

Title

Administrator

Phone

(910) 441-8563

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234396800000",
    "number": "1992944177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 673",
            "city": "ROSE HILL",
            "state": "NC",
            "postal_code": "284580673",
            "telephone_number": "910-289-2422",
            "fax_number": "910-289-2734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 ASH STREET",
            "city": "ROSE HILL",
            "state": "NC",
            "postal_code": "28458",
            "telephone_number": "910-289-2422",
            "fax_number": "910-289-2734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE STREET YOUTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-12",
        "last_updated": "2009-02-12",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "ALFRED",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-441-8563",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-031-068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Rose Hill, NC
• Providers in Rose Hill, NC by specialty
• Mental Illness 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 Feb 12, 2009; 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.