Healthcare Provider Details

I. General information

NPI: 1255287207
Provider Name (Legal Business Name): CARIBBEAN PALACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N MARKET ST # C100
BENSON NC
27504-1514
US

IV. Provider business mailing address

101 N MARKET ST # C100
BENSON NC
27504-1514
US

V. Phone/Fax

Practice location:
  • Phone: 252-645-9193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL GREGORY FULTON
Title or Position: OWNER
Credential: MS
Phone: 252-645-9193