Provider Demographics
NPI:1053786087
Name:RUSSELL MEADOWS INSTITUTE
Entity type:Organization
Organization Name:RUSSELL MEADOWS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-607-2041
Mailing Address - Street 1:308 W MILLBROOK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4574
Mailing Address - Country:US
Mailing Address - Phone:919-890-5569
Mailing Address - Fax:
Practice Address - Street 1:2104 WINNIE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-2775
Practice Address - Country:US
Practice Address - Phone:919-758-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSMED CONSUTLANTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services