Provider Demographics
NPI:1336285097
Name:CHESTERFIELD ADULT CARE HOME INC.
Entity Type:Organization
Organization Name:CHESTERFIELD ADULT CARE HOME INC.
Other - Org Name:CACH, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:CARSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-437-5164
Mailing Address - Street 1:2658 PAX HILL RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7754
Mailing Address - Country:US
Mailing Address - Phone:828-437-5164
Mailing Address - Fax:828-437-7181
Practice Address - Street 1:2630 PAX HILL RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7754
Practice Address - Country:US
Practice Address - Phone:828-437-5164
Practice Address - Fax:828-437-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL 012024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805105Medicaid