Provider Demographics
NPI:1710544788
Name:CARRIAGE RESIDENTIAL CARE CENTER, LLC
Entity Type:Organization
Organization Name:CARRIAGE RESIDENTIAL CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-330-3760
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-0272
Mailing Address - Country:US
Mailing Address - Phone:573-330-3760
Mailing Address - Fax:
Practice Address - Street 1:508 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1756
Practice Address - Country:US
Practice Address - Phone:573-330-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness