Provider Demographics
NPI:1831189141
Name:CAROLINA VILLAGE, INC.
Entity type:Organization
Organization Name:CAROLINA VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-692-6275
Mailing Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-1800
Mailing Address - Country:US
Mailing Address - Phone:828-692-6275
Mailing Address - Fax:828-692-7876
Practice Address - Street 1:600 CAROLINA VILLAGE RD STE Z
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-1800
Practice Address - Country:US
Practice Address - Phone:828-692-6275
Practice Address - Fax:828-692-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0400X, 311ZA0620X
NCNH0174314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC345123Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER