Healthcare Provider Details

I. General information

NPI: 1881825529
Provider Name (Legal Business Name): CARILLON ASSISTED LIVING OF MONROE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5306 SECREST SHORT CUT RD
MONROE NC
28110
US

IV. Provider business mailing address

4901 WATERS EDGE DR SUITE 200
RALEIGH NC
27606-2464
US

V. Phone/Fax

Practice location:
  • Phone: 919-852-4000
  • Fax: 919-852-4001
Mailing address:
  • Phone: 919-852-4000
  • Fax: 919-852-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN MARK JOHNSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 919-852-4000