Basic Information
| Provider Information | |||||||||
| NPI: | 1184062937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARILLON ASSISTED LIVING OF RALEIGH-OLD WAKE FOREST ROAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 WATERS EDGE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276062464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198524000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5219 OLD WAKE FOREST RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276095007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198766316 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | KROPP | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9198524000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 311ZA0620X | HAL-092-187 | NC | Y | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No ID Information.