Provider Demographics
NPI:1942418678
Name:CARILLON ASSISTED LIVING OF SHELBY
Entity Type:Organization
Organization Name:CARILLON ASSISTED LIVING OF SHELBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MADERIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:4901 WATERS EDGE DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2464
Mailing Address - Country:US
Mailing Address - Phone:919-852-4000
Mailing Address - Fax:919-852-4001
Practice Address - Street 1:1550 CHARLES RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7036
Practice Address - Country:US
Practice Address - Phone:704-471-2828
Practice Address - Fax:704-471-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-023-027177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804048Medicaid