Provider Demographics
NPI:1285861500
Name:CARRABAUN
Entity Type:Organization
Organization Name:CARRABAUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-829-4411
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-0710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 MCAULEY CIRCLE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-0710
Practice Address - Country:US
Practice Address - Phone:704-829-4418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY ANGELS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-12
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 311ZA0620X
NCMHL-036-111320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619310851OtherSTATE FUNDS THROUGH PARTNERS MCO
NC7802692Medicaid
NC7803423Medicaid