Provider Demographics
NPI:1689401234
Name:RESTORATIVE COMMUNITY SUPPORT SERVICES CO
Entity type:Organization
Organization Name:RESTORATIVE COMMUNITY SUPPORT SERVICES CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAELENE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:252-402-2781
Mailing Address - Street 1:320 N HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-5030
Mailing Address - Country:US
Mailing Address - Phone:252-402-2781
Mailing Address - Fax:
Practice Address - Street 1:320 N HARVEY ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-5030
Practice Address - Country:US
Practice Address - Phone:252-402-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children