Carolina Prime Residential LLC
Organization Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Eden, NC
NPI 1215545348 · NPPES record last updated Apr 10, 2024
Key facts
- NPI
- 1215545348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
- Legal business name
- CAROLINA PRIME RESIDENTIAL LLC
- Practice address
- 315 Maple St
Eden, NC 27288-5513 - Phone
- (336) 623-1020
- NPI assigned
- Jul 15, 2020
- Organization subpart
- No
Authorized official
- Name
- Mrs. Mikisha Simms
- Title
- Director
- Phone
- (301) 717-2040
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Illness Community Based Residential Treatment Facility | 320800000X | |||
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | Yes |
Addresses
Primary practice location
315 Maple St
Eden, NC 27288-5513
Mailing address
315 Maple St
Eden, NC 27288-5513
Phone (336) 763-5620
Other providers in Eden, NC
- Michael D Burleson
- But God LLC
- Care First Home Health Care, Inc
- Care of Diversity, LLC
- Carolina Apothecary Inc
- Aaron Carpenter
- Joe Gray Carpenter
- Erin Jones Carroll
- Kelsey Carter
- Angel G Cassell
All providers in Eden, NC · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.