Healthcare Provider Details

I. General information

NPI: 1619963832
Provider Name (Legal Business Name): CAROLINAS ANSON HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MORVEN RD
WADESBORO NC
28170-2745
US

IV. Provider business mailing address

500 MORVEN RD
WADESBORO NC
28170-2745
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-5131
  • Fax: 704-694-3900
Mailing address:
  • Phone: 704-694-5131
  • Fax: 704-694-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberH0082
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN G MOORE
Title or Position: CFO
Credential:
Phone: 704-694-5131