Basic Information
| Provider Information | |||||||||
| NPI: | 1114191921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARILLON ASSISTED LIVING OF LINCOLNTON, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 WATERS EDGE DR | ||||||||
| Address2: | 200 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276062464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198524000 | ||||||||
| FaxNumber: | 9198524001 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 SALEM CHURCH ROAD | ||||||||
| Address2: | |||||||||
| City: | LINCOLNTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280928856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047320029 | ||||||||
| FaxNumber: | 7047320089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | MADERIOS | ||||||||
| AuthorizedOfficialFirstName: | EVIE | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTS RECEIVABLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9198524000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 177F00000X | HAL-055-011 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Lodging |
No ID Information.