MEDICARE: CARILLON ASSISTED LIVING OF N DURHAM

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1174116453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARILLON ASSISTED LIVING OF N DURHAM

Provider Business Mailing Address
First Line	:	4901 WATERS EDGE DR STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-2464
Country	:	US
Telephone Number	:	919-852-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4214 GUESS RD
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27712-3104
Country	:	US
Telephone Number	:	919-471-0091
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KAREN E MORIARTY
Credential	:
Telephone Number	:	919-471-0091

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	03/02/2021

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