Provider Demographics
NPI:1164554234
Name:CARSWELL, SHIRLEY JEAN
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:CARSWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 ROB CARSWELL ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9438
Mailing Address - Country:US
Mailing Address - Phone:828-438-2886
Mailing Address - Fax:828-437-0429
Practice Address - Street 1:5415 ROB CARSWELL ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-9438
Practice Address - Country:US
Practice Address - Phone:828-437-6544
Practice Address - Fax:828-437-0429
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL 012017310400000X
NCFCL 012026310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802855Medicaid
NC7805376Medicaid