Provider Demographics
NPI:1184726739
Name:SIERRA'S RESIDENTIAL SERVICES, INC.
Entity type:Organization
Organization Name:SIERRA'S RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTTIE
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:VANHOOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:910-257-1156
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-0655
Mailing Address - Country:US
Mailing Address - Phone:910-257-1156
Mailing Address - Fax:919-498-6289
Practice Address - Street 1:1995 US 421 N
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-7436
Practice Address - Country:US
Practice Address - Phone:910-814-4243
Practice Address - Fax:910-814-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0020921041C0700X
251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300458GMedicaid
NC8300458Medicaid
NC8300458BMedicaid