Basic Information
Provider Information | |||||||||
NPI: | 1295279594 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CAROLINA CARE HEALTH AND REHABILITATION, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CAROLINA CARE HEALTH AND REHABILITATION | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 111 HARRELSON RD | ||||||||
Address2: |   | ||||||||
City: | CHERRYVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 280219541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7044354161 | ||||||||
FaxNumber: | 7044358979 | ||||||||
Practice Location | |||||||||
Address1: | 111 HARRELSON RD | ||||||||
Address2: |   | ||||||||
City: | CHERRYVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 280219541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7044354161 | ||||||||
FaxNumber: | 7044358979 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/06/2016 | ||||||||
LastUpdateDate: | 04/26/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SPRENGER | ||||||||
AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
AuthorizedOfficialMiddleName: | JOHN | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 9196089123 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/26/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | NH0287 | NC | N |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   | 314000000X | NH0287 | NC | Y |   | Nursing & Custodial Care Facilities | Skilled Nursing Facility |   |
ID Information
ID | Type | State | Issuer | Description | 34-05255 | 05 | NC |   | MEDICAID |