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General NPI Number Information
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NPI Number | 1467834283
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Entity Type | Organization
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Legal Business Name | CAROLINA CARE AND MANAGEMENT LLC
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 143 ROSEDALE DR
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9810
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Country | US
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Telephone | 252-562-6593
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Fax |
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Provider Business Mailing Address
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Address Line | 143 ROSEDALE DR
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-9810
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Country | US
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Telephone | 252-562-6593
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Fax |
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Authorized Official
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Title or Position | OPERATIONS ADVISOR
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Name | DANA SMITH
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Credential | RPH
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Telephone | 252-562-6593
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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 | HAL-078-101
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License Number State | NC
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