Provider Demographics
NPI:1063545549
Name:KARA CARE HOME
Entity type:Organization
Organization Name:KARA CARE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALEMATOU
Authorized Official - Middle Name:
Authorized Official - Last Name:DIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-599-5548
Mailing Address - Street 1:712 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2462
Mailing Address - Country:US
Mailing Address - Phone:919-599-5548
Mailing Address - Fax:919-554-0023
Practice Address - Street 1:712 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2462
Practice Address - Country:US
Practice Address - Phone:919-599-5548
Practice Address - Fax:919-554-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 0925883104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804979Medicaid