Provider Demographics
NPI:1073599510
Name:CAROMONT HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:CAROMONT HEALTH SERVICES INC.
Other - Org Name:COURTLAND TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHOVELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-834-2121
Mailing Address - Street 1:2300 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0613
Mailing Address - Country:US
Mailing Address - Phone:704-834-4800
Mailing Address - Fax:704-834-4812
Practice Address - Street 1:2300 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0613
Practice Address - Country:US
Practice Address - Phone:704-834-4800
Practice Address - Fax:704-834-4812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0494314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3405350Medicaid
NC3406314Medicaid
NC7802312Medicaid
NC0532000001Medicare NSC
NC7802312Medicaid