Provider Demographics
NPI:1932242252
Name:CRESCENT GREEN OF CARRBORO, INC
Entity Type:Organization
Organization Name:CRESCENT GREEN OF CARRBORO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-933-9570
Mailing Address - Street 1:624 JONES FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510
Mailing Address - Country:US
Mailing Address - Phone:919-933-9570
Mailing Address - Fax:919-933-9572
Practice Address - Street 1:624 JONES FERRY ROAD
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510
Practice Address - Country:US
Practice Address - Phone:919-933-9570
Practice Address - Fax:919-933-9572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-068-024310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805622Medicaid