Provider Demographics
NPI:1902149875
Name:CAROLINA CARE
Entity Type:Organization
Organization Name:CAROLINA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORRGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-449-9639
Mailing Address - Street 1:PO BOX 541421
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1421
Mailing Address - Country:US
Mailing Address - Phone:321-449-9639
Mailing Address - Fax:
Practice Address - Street 1:2460 KATHI KIM ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5372
Practice Address - Country:US
Practice Address - Phone:332-144-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10753310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility