Healthcare Provider Details

I. General information

NPI: 1073599510
Provider Name (Legal Business Name): CAROMONT HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 ABERDEEN BLVD
GASTONIA NC
28054-0613
US

IV. Provider business mailing address

2300 ABERDEEN BLVD
GASTONIA NC
28054-0613
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-4800
  • Fax: 704-834-4812
Mailing address:
  • Phone: 704-834-4800
  • Fax: 704-834-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0494
License Number StateNC

VIII. Authorized Official

Name: MR. WAYNE F. SHOVELIN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 704-834-2121