Provider Demographics
NPI:1285819029
Name:YANCEY RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:YANCEY RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:STYLES
Authorized Official - Suffix:
Authorized Official - Credentials:QDDP
Authorized Official - Phone:828-682-4944
Mailing Address - Street 1:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28714-0849
Mailing Address - Country:US
Mailing Address - Phone:828-682-4944
Mailing Address - Fax:828-682-9813
Practice Address - Street 1:35 CELO ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28714-3008
Practice Address - Country:US
Practice Address - Phone:828-682-4944
Practice Address - Fax:828-682-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL100-013320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408878Medicaid