Carillon Assisted Living of Wake Forest LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

License

HAL-092-193 Issued in NC

Legal business name

CARILLON ASSISTED LIVING OF WAKE FOREST LLC

Practice address

3218 Heritage Trade Dr
Wake Forest, NC 27587-4238

Phone

(919) 569-2101

Fax

(919) 569-2102

NPI assigned

Jul 10, 2014

Last updated

Sep 15, 2014By the provider in NPPES

Organization subpart

Yes

Parent organization

CARILLON ASSISTED LIVING, LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Karen Elena Moriarty

Title

President and Ceo

Phone

(919) 852-4000

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1404950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410739200000",
    "number": "1639585649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3218 HERITAGE TRADE DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874238",
            "telephone_number": "919-569-2101",
            "fax_number": "919-569-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3218 HERITAGE TRADE DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275874238",
            "telephone_number": "919-569-2101",
            "fax_number": "919-569-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARILLON ASSISTED LIVING OF WAKE FOREST LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARILLON ASSISTED LIVING, LLC",
        "enumeration_date": "2014-07-10",
        "last_updated": "2014-09-15",
        "status": "A",
        "authorized_official_last_name": "MORIARTY",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ELENA",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "919-852-4000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": "NC",
            "license": "HAL-092-193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Custodial Care Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.