=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427129253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEPHEN R CARTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12436 ROYAL RD
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92021-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-443-3886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2427
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92021-0427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-443-3886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NHA OWNER
-----------------------------------------------------
Name | MR. STEPHEN RANDALL CARTER
-----------------------------------------------------
Credential | NURSING HOME ADMINIS
-----------------------------------------------------
Telephone | 619-277-4350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 080000090
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------