Provider Demographics
NPI:1760821003
Name:CAROLINA CARE HOMES INC
Entity Type:Organization
Organization Name:CAROLINA CARE HOMES INC
Other - Org Name:CAROLINA CARE HOME #2
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-269-3283
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:4025 PISGAH RD
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-1300
Mailing Address - Country:US
Mailing Address - Phone:828-321-4272
Mailing Address - Fax:
Practice Address - Street 1:4025 PISGAH RD
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901-1300
Practice Address - Country:US
Practice Address - Phone:828-321-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLNA CARE HOMES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL020002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802399Medicaid
NCHAL020002OtherDHHS LICENSE