Caromont Health Services Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH0494 Issued in NC

Legal business name

CAROMONT HEALTH SERVICES INC.

Practice address

2300 Aberdeen Blvd
Gastonia, NC 28054-0613

Phone

(704) 834-4800

Fax

(704) 834-4812

NPI assigned

Dec 16, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Wayne F. Shovelin

Title

President/Ceo

Phone

(704) 834-2121

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Courtland Terrace Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Skilled nursing facility certification: CCN 345350

Legal name

CAROMONT HEALTH SERVICES INC

Doing business as

COURTLAND TERRACE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 31, 1991

Last certification

Oct 31, 2024

Beds

96 (77 certified)

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

May 24, 1984 in NC

Enrollment address

2300 Aberdeen Blvd
Gastonia, NC 28054-0613

Nursing home name

COURTLAND TERRACE

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Caromont Health Services, Inc.

  • Ambulatory Surgical Clinic/Center
  • Gastonia, NC
  • NPI 1902895675

  2860441052

  Same PAC ID

Listed as

Courtland TerraceCCN 345350

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Jan 31, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7771.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Caromont Specialty Surgery5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Caromont Health Services, Inc.

  • Radiology Clinic/Center
  • Belmont, NC
  • NPI 1356263313
  NPD tax ID
• Caromont Health Services, Inc.

  • Ambulatory Surgical Clinic/Center
  • Belmont, NC
  • NPI 1790066876
  NPD tax ID
• Caromont Health Services, Inc.

  • Ambulatory Surgical Clinic/Center
  • Gastonia, NC
  • NPI 1902895675
  NPD tax ID
• Caromont Health Services, Inc.

  • Mobile Radiology Clinic/Center
  • Gastonia, NC
  • NPI 1982526935
  NPD tax ID

All disclosed owners & managing parties 67

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• George Edward Adcock III, M.D.

  • Obstetrics & Gynecology Physician
  • Gastonia, NC
  • NPI 1447246228

  Operational/Managerial Control

  CMS ownership
• Caromont Health Services, Inc.

  • Ambulatory Surgical Clinic/Center
  • Gastonia, NC
  • NPI 1902895675

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Andrew J Dyksterhouse, M.D.

  • Family Medicine Physician
  • Belmont, NC
  • NPI 1831151596

  Operational/Managerial Control

  CMS ownership
• Crystal Cornelia Maddox, M.D.

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1942520937

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Shiddhi P Patel, M.D.

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1275936502

  Adp of the SNF, Corporate Director

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Caromont Serious Illness Partners, LLC

  • Community Based Hospice Care Agency
  • Gastonia, NC
  • NPI 1780419523

  Caromont Health Inc

  CMS ownership
• Gaston Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Gastonia, NC
  • NPI 1013918960

  Caromont Health Inc

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Crystal Cornelia Maddox, M.D.

  • Family Medicine Physician
  • Gastonia, NC
  • NPI 1942520937

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1073599510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 ABERDEEN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540613",
            "telephone_number": "704-834-4800",
            "fax_number": "704-834-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 ABERDEEN BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280540613",
            "telephone_number": "704-834-4800",
            "fax_number": "704-834-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROMONT HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "SHOVELIN",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "704-834-2121",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405350",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3406314",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7802312",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courtland Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Caromont Health Retail Pharmacy LLC
• Caromont Health Services, Inc.
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• Caromont Internal Medicine 2LLC
• Caromont Medical Group Inc
• Caromont Medical Group Inc

• Skilled Nursing Facility in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.