Basic Information
| Provider Information | |||||||||
| NPI: | 1184057390 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARILLON ASSISTED LIVING OF MOORESVILLE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 WATERS EDGE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276062464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198524000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 198 E WATERLYNN RD | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281178074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046608000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2013 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | MORIARTY | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO & PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9198524000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CARILLON ASSISTED LIVING, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.