1417163643 NPI number — RESIDENTIAL & SUPPORT SERVICES, INC.

Table of content: (NPI 1417163643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417163643 NPI number — RESIDENTIAL & SUPPORT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESIDENTIAL & SUPPORT 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:
1417163643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4425 RANDOLPH RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-2351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-536-6661
Provider Business Mailing Address Fax Number:
704-536-0074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4425 RANDOLPH RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28211-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-536-6661
Provider Business Practice Location Address Fax Number:
704-536-0074
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOUGEON
Authorized Official First Name:
LORI
Authorized Official Middle Name:
A
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
704-536-6661

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 73735166 . This is a "SUPERVISED LIVING PERIODI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com