Provider Demographics
NPI:1699079715
Name:CARILLON ASSISTED LIVING OF KNIGHTDALE, LLC
Entity type:Organization
Organization Name:CARILLON ASSISTED LIVING OF KNIGHTDALE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:4901 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2464
Mailing Address - Country:US
Mailing Address - Phone:919-852-4000
Mailing Address - Fax:919-852-4001
Practice Address - Street 1:2408 HODGE RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9386
Practice Address - Country:US
Practice Address - Phone:919-852-4000
Practice Address - Fax:919-852-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility