Provider Demographics
NPI:1376065003
Name:CARILLON ASSISTED LIVING OF MINT HILL, LLC
Entity type:Organization
Organization Name:CARILLON ASSISTED LIVING OF MINT HILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:5601 MARGARET WALLACE ROAD
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-573-4000
Mailing Address - Fax:704-573-4002
Practice Address - Street 1:5601 MARGARET WALLACE ROAD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-573-4000
Practice Address - Fax:704-573-4002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARILLON ASSISTED LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility