Provider Demographics
NPI:1093030777
Name:ADULT CARE OF THE CAROLINAS INC
Entity Type:Organization
Organization Name:ADULT CARE OF THE CAROLINAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-444-9956
Mailing Address - Street 1:936 7TH ST
Mailing Address - Street 2:SUITE B #129
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-3010
Mailing Address - Country:US
Mailing Address - Phone:480-444-9956
Mailing Address - Fax:480-323-2371
Practice Address - Street 1:2860 NEW CUT RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-6332
Practice Address - Country:US
Practice Address - Phone:864-439-7347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-0384310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility