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General NPI Number Information
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NPI Number | 1639585649
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Entity Type | Organization
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Legal Business Name | CARILLON ASSISTED LIVING OF WAKE FOREST LLC
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 3218 HERITAGE TRADE DR
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City | WAKE FOREST
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State | NC
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Zip | 27587-4238
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Country | US
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Telephone | 919-569-2101
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Fax | 919-569-2102
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Provider Business Mailing Address
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Address Line | 3218 HERITAGE TRADE DR
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City | WAKE FOREST
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State | NC
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Zip | 27587-4238
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Country | US
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Telephone | 919-569-2101
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Fax | 919-569-2102
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MRS. KAREN ELENA MORIARTY
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Credential |
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Telephone | 919-852-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | HAL-092-193
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License Number State | NC
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