Provider Demographics
NPI:1619118809
Name:SELECT CARE HOME SERVICES LLC
Entity type:Organization
Organization Name:SELECT CARE HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHIDI
Authorized Official - Suffix:
Authorized Official - Credentials:QPMH/MR/DD
Authorized Official - Phone:314-283-2476
Mailing Address - Street 1:3406 SOSA RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-4097
Mailing Address - Country:US
Mailing Address - Phone:314-283-2476
Mailing Address - Fax:
Practice Address - Street 1:233 GHOLSON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4547
Practice Address - Country:US
Practice Address - Phone:314-283-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children