Provider Demographics
NPI:1962804690
Name:RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-942-7391
Mailing Address - Street 1:111 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2229
Mailing Address - Country:US
Mailing Address - Phone:919-942-7391
Mailing Address - Fax:919-933-4490
Practice Address - Street 1:106 ABERDEEN CT
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1218
Practice Address - Country:US
Practice Address - Phone:919-967-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-068-093251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406331Medicaid
NC7804543Medicaid
NC7804546Medicaid
NC7804547Medicaid
NC7806709Medicaid
NC3406544Medicaid
NC7804548Medicaid
NC7804896Medicaid
NC7805754Medicaid
NC3406482Medicaid
NC3406356Medicaid
NC8300572Medicaid
NC340603PMedicaid
NC340610UMedicaid
NC3408164Medicaid
NC7804544Medicaid
NC7804545Medicaid
NC7806030Medicaid