Provider Demographics
NPI:1093875957
Name:CAREBRIDGE ASSISTED LIVING
Entity Type:Organization
Organization Name:CAREBRIDGE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-394-2200
Mailing Address - Street 1:30 DEPOT ST W
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2930
Mailing Address - Country:US
Mailing Address - Phone:540-394-2200
Mailing Address - Fax:540-394-2201
Practice Address - Street 1:935 PAGE ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-9735
Practice Address - Country:US
Practice Address - Phone:704-346-2923
Practice Address - Fax:704-436-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL013016310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805178Medicaid