Carillon Assisted Living of Fayetteville, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

CARILLON ASSISTED LIVING OF FAYETTEVILLE, LLC

Doing business as

Carillon Assisted Living of Fayetteville

Practice address

1164 71St School Rd
Fayetteville, NC 28314-2817

Phone

(919) 852-4000

Fax

(919) 852-4001

NPI assigned

Jul 27, 2009

Last updated

Jul 27, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Mark Johnson

Title

Chief Financial Officer

Phone

(919) 852-4000

Specialties & licenses 1

Addresses

Other names 1

• Carillon Assisted Living of Fayetteville Doing business as

Locations

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1871723791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 WATERS EDGE DR",
            "address_2": "SUITE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276062464",
            "telephone_number": "919-852-4000",
            "fax_number": "919-852-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1164 71ST SCHOOL RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283142817",
            "telephone_number": "919-852-4000",
            "fax_number": "919-852-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARILLON ASSISTED LIVING OF FAYETTEVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "919-852-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carillon Assisted Living of Fayetteville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.