MEDICARE: CAROLINA CARE OF HALIFAX, 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	310400000X	Assisted Living Facility	HAL-042-005	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528143989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CARE OF HALIFAX, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1487
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27285-1487
Country	:	US
Telephone Number	:	336-595-1075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1361 CAROLINA REST HOME RD
Second Line	:
City	:	ROANOKE RAPIDS
State	:	NC
Zip	:	27870-8653
Country	:	US
Telephone Number	:	252-533-0014
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	GUY S PIERCE
Credential	:
Telephone Number	:	336-595-1075

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/22/2020

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