Provider Demographics
NPI:1588780043
Name:CARRIE CARE ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:CARRIE CARE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-889-1617
Mailing Address - Street 1:1539 KENNEWICK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2208
Mailing Address - Country:US
Mailing Address - Phone:410-889-1617
Mailing Address - Fax:410-889-2129
Practice Address - Street 1:1539 KENNEWICK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2208
Practice Address - Country:US
Practice Address - Phone:410-889-1617
Practice Address - Fax:410-889-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30232789530Medicaid