Provider Demographics
NPI:1184825747
Name:CAROLINA LIVING CENTER
Entity Type:Organization
Organization Name:CAROLINA LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-9560
Mailing Address - Street 1:1308 HEBRON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-5527
Mailing Address - Country:US
Mailing Address - Phone:828-692-9560
Mailing Address - Fax:
Practice Address - Street 1:1308 HEBRON ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-5527
Practice Address - Country:US
Practice Address - Phone:828-692-9560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL045026261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFCL045026Medicare UPIN
NCFCL 045007Medicare UPIN