Healthcare Provider Details

I. General information

NPI: 1295279594
Provider Name (Legal Business Name): CAROLINA CARE HEALTH AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HARRELSON RD
CHERRYVILLE NC
28021-9541
US

IV. Provider business mailing address

111 HARRELSON RD
CHERRYVILLE NC
28021-9541
US

V. Phone/Fax

Practice location:
  • Phone: 704-435-4161
  • Fax: 704-435-8979
Mailing address:
  • Phone: 704-435-4161
  • Fax: 704-435-8979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNH0287
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0287
License Number StateNC

VIII. Authorized Official

Name: MR. CHRISTOPHER JOHN SPRENGER
Title or Position: MANAGER
Credential:
Phone: 919-608-9123