MEDICARE: CARRINGTON-LTC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1073967030
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRINGTON-LTC, LLC

Provider Business Mailing Address
First Line	:	10945 STATE BRIDGE RD
Second Line	:	SUITE 401-470
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-8164
Country	:	US
Telephone Number	:	678-381-2810
Fax Number	:	678-381-2811

Provider Business Practice Location Address
First Line	:	2406 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-2148
Country	:	US
Telephone Number	:	434-846-3200
Fax Number	:	434-846-3436

Authorized Official
Title or Position	:	MEMBER/CFO
Name	:	DAREN DOUSTON
Credential	:
Telephone Number	:	678-381-2810

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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