1063555886 NPI number — CAROLINA RESIDENTIAL SERVICES, INC

Table of content: MANDY SMITH JONES MAED, LPC (NPI 1730364449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063555886 NPI number — CAROLINA RESIDENTIAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA RESIDENTIAL SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063555886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 286
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTHERFORD COLLEGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28671-0286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-572-2333
Provider Business Mailing Address Fax Number:
980-225-0500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 BURKE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28655-5395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-438-6284
Provider Business Practice Location Address Fax Number:
828-438-6276
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KINCAID
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
828-572-2333

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  MHL-012-010 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8301036S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303427S , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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