Provider Demographics
NPI:1184062937
Name:CARILLON ASSISTED LIVING OF RALEIGH-OLD WAKE FOREST ROAD
Entity type:Organization
Organization Name:CARILLON ASSISTED LIVING OF RALEIGH-OLD WAKE FOREST ROAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KROPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:4901 WATERS EDGE DR
Mailing Address - Street 2:SUITE 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:
Practice Address - Street 1:5219 OLD WAKE FOREST RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5007
Practice Address - Country:US
Practice Address - Phone:919-876-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-187311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home