Provider Demographics
NPI:1275524027
Name:CARILLON, INC.
Entity Type:Organization
Organization Name:CARILLON, INC.
Other - Org Name:CARILLON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MCCLENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-763-9561
Mailing Address - Street 1:1717 NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-6099
Mailing Address - Country:US
Mailing Address - Phone:806-281-6000
Mailing Address - Fax:806-281-6041
Practice Address - Street 1:1717 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416
Practice Address - Country:US
Practice Address - Phone:806-281-6000
Practice Address - Fax:806-281-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148539310400000X
TX146447310400000X
TX103309311500000X
TX145619314000000X
TX137654310400000X
TX140599314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675997Medicare Oscar/Certification