Healthcare Provider Details

I. General information

NPI: 1144804485
Provider Name (Legal Business Name): CAROLINA BURKE OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 MILLER BRIDGE RD
CONNELLY SPRINGS NC
28612-7347
US

IV. Provider business mailing address

3647 MILLER BRIDGE RD
CONNELLY SPRINGS NC
28612-7347
US

V. Phone/Fax

Practice location:
  • Phone: 828-379-3144
  • Fax:
Mailing address:
  • Phone:
  • 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: ASHLEY RADER
Title or Position: ADMINISTRATOR
Credential:
Phone: 828-379-3144