Healthcare Provider Details

I. General information

NPI: 1114188737
Provider Name (Legal Business Name): CAROLINA CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HARRILSON RD
CHERRYVILLE NC
28021-9541
US

IV. Provider business mailing address

111 HARRILSON RD
CHERRYVILLE NC
28021-9541
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CARMEN QUEEN GRIFFIN
Title or Position: OTR
Credential:
Phone: 704-692-4483