Provider Demographics
NPI:1619963832
Name:CAROLINAS ANSON HEALTHCARE, INC.
Entity Type:Organization
Organization Name:CAROLINAS ANSON HEALTHCARE, INC.
Other - Org Name:LILLIE BENNETT NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-694-5131
Mailing Address - Street 1:500 MORVEN RD
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2745
Mailing Address - Country:US
Mailing Address - Phone:704-694-5131
Mailing Address - Fax:704-694-3900
Practice Address - Street 1:500 MORVEN RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2745
Practice Address - Country:US
Practice Address - Phone:704-694-5131
Practice Address - Fax:704-694-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0082314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415051Medicaid
NC3416531Medicaid
NC1315600001OtherDURABLE MEDICAL EQUIPMENT
NC1315600001OtherDURABLE MEDICAL EQUIPMENT