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General NPI Number Information
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NPI Number | 1073599510
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Entity Type | Organization
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Legal Business Name | CAROMONT HEALTH SERVICES INC.
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 2300 ABERDEEN BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-0613
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Country | US
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Telephone | 704-834-4800
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Fax | 704-834-4812
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Provider Business Mailing Address
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Address Line | 2300 ABERDEEN BLVD
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City | GASTONIA
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State | NC
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Zip | 28054-0613
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Country | US
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Telephone | 704-834-4800
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Fax | 704-834-4812
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. WAYNE F. SHOVELIN
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Credential |
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Telephone | 704-834-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH0494
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License Number State | NC
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