Healthcare Provider Details

I. General information

NPI: 1861003485
Provider Name (Legal Business Name): THE CARROLTON OF PLYMOUTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 US HIGHWAY 64 E
PLYMOUTH NC
27962-9215
US

IV. Provider business mailing address

PO BOX 8427
ROCKY MOUNT NC
27804-1427
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-2100
  • 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: SONYA ROZIER
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 910-474-4381