Healthcare Provider Details

I. General information

NPI: 1902440118
Provider Name (Legal Business Name): CAROLINAS ALLIANCE FOR RESIDENTIAL EXCELLENCE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 JOHNSON RIDGE RD
ELKIN NC
28621-2420
US

IV. Provider business mailing address

430 PINEOLA ST STE 300
NEWLAND NC
28657-7603
US

V. Phone/Fax

Practice location:
  • Phone: 855-677-1188
  • Fax: 855-677-1189
Mailing address:
  • Phone: 855-677-1188
  • Fax: 855-677-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: LAUREN ASHLEY REAVIS WARE
Title or Position: COO
Credential: RN, MSN, MBA
Phone: 336-408-5008