Provider Demographics
NPI:1730184102
Name:CAROLINA ADVENTIST RETIREMENT SYSTEMS INC
Entity type:Organization
Organization Name:CAROLINA ADVENTIST RETIREMENT SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-418-2334
Mailing Address - Street 1:1075 US HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7628
Mailing Address - Country:US
Mailing Address - Phone:252-338-3975
Mailing Address - Fax:252-338-0039
Practice Address - Street 1:1075 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7628
Practice Address - Country:US
Practice Address - Phone:252-338-3975
Practice Address - Fax:252-338-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2013-07-31
Deactivation Date:2007-01-30
Deactivation Code:
Reactivation Date:2007-04-10
Provider Licenses
StateLicense IDTaxonomies
NCNH0040314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00933OtherBLUE CROSS BLUE SHIELD
NC3415036Medicaid
NC00933OtherBLUE CROSS BLUE SHIELD
NC3415036Medicaid