Provider Demographics
NPI:1760967558
Name:CAROLINA VILLAGE, INC.
Entity Type:Organization
Organization Name:CAROLINA VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-6275
Mailing Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2845
Mailing Address - Country:US
Mailing Address - Phone:828-692-6275
Mailing Address - Fax:828-692-7876
Practice Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2845
Practice Address - Country:US
Practice Address - Phone:828-692-6275
Practice Address - Fax:828-692-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation