Provider Demographics
NPI:1578777587
Name:CAROLE C MCGALLIARD
Entity Type:Organization
Organization Name:CAROLE C MCGALLIARD
Other - Org Name:SUNNYSIDE GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCGALLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-437-6508
Mailing Address - Street 1:1940 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1940 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7419
Practice Address - Country:US
Practice Address - Phone:828-437-6508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-012099310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805322Medicaid