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General NPI Number Information
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NPI Number | 1215066147
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Entity Type | Organization
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Legal Business Name | CAROLINA CARE CENTER OF CHERRYVILLE, INC.
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 111 HARRILSON RD
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City | CHERRYVILLE
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State | NC
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Zip | 28021-9541
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Country | US
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Telephone | 704-435-4161
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Fax | 704-435-8979
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Provider Business Mailing Address
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Address Line | 111 HARRILSON RD
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City | CHERRYVILLE
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State | NC
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Zip | 28021-9541
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Country | US
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Telephone | 704-435-4161
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Fax | 704-435-8979
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JUDY BEAM BEAM
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Credential | NHA
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Telephone | 704-435-4161
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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 | NH0287
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License Number State | NC
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