Provider Demographics
NPI:1083037436
Name:DUTCHESS RESIDENTIAL CARE
Entity type:Organization
Organization Name:DUTCHESS RESIDENTIAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED ADMINISTRTIVE OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-986-6565
Mailing Address - Street 1:103 THENSIA CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4251
Mailing Address - Country:US
Mailing Address - Phone:919-521-8112
Mailing Address - Fax:
Practice Address - Street 1:103 THENSIA CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4251
Practice Address - Country:US
Practice Address - Phone:919-521-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-092-733320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities