Provider Demographics
NPI:1639585649
Name:CARILLON ASSISTED LIVING OF WAKE FOREST LLC
Entity Type:Organization
Organization Name:CARILLON ASSISTED LIVING OF WAKE FOREST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:3218 HERITAGE TRADE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4238
Mailing Address - Country:US
Mailing Address - Phone:919-569-2101
Mailing Address - Fax:919-569-2102
Practice Address - Street 1:3218 HERITAGE TRADE DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4238
Practice Address - Country:US
Practice Address - Phone:919-569-2101
Practice Address - Fax:919-569-2102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARILLON ASSISTED LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-10
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-193311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility