Provider Demographics
NPI:1811449796
Name:RENFROE, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RENFROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 SGODA RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8855
Mailing Address - Country:US
Mailing Address - Phone:478-742-6934
Mailing Address - Fax:478-745-1259
Practice Address - Street 1:4732 SGODA RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8855
Practice Address - Country:US
Practice Address - Phone:478-742-6934
Practice Address - Fax:478-745-1259
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility