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General NPI Number Information
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NPI Number | 1174167381
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Entity Type | Organization
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Legal Business Name | CAROLINAS ALLIANCE FOR RESIDENTIAL EXCELLENCE - ELKIN LLC
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Dates
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Enumeration Date | 10/30/2019
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Last Update Date | 10/30/2019
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Provider Practice Location Address
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Address Line | 500 JOHNSON RIDGE RD
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City | ELKIN
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State | NC
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Zip | 28621-2420
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Country | US
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Telephone | 855-677-1188
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Fax | 855-677-1189
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Provider Business Mailing Address
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Address Line | 430 PINEOLA ST STE 300
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City | NEWLAND
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State | NC
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Zip | 28657-7603
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Country | US
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Telephone | 855-677-1188
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Fax | 855-677-1189
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Authorized Official
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Title or Position | COO
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Name | LAUREN ASHLEY REAVIS WARE
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Credential | RN
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Telephone | 336-408-5008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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