National Provider Identifier Database

CARILLON ASSISTED LIVING OF SOUTHPORT
Lodging

A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home.


Contact Information

CARILLON ASSISTED LIVING OF SOUTHPORT
1125 E LEONARD ST
SOUTHPORT, NC28461-8316
Phone: 910-454-4001
Fax: 910-454-0300
Website:
Specialty Taxonomy Code
* Lodging 177F00000X

* Indicates primary specialty

NPI Profile & details for CARILLON ASSISTED LIVING OF SOUTHPORT

NPI Number 1215145966
Legal business name
LBN
CARILLON ASSISTED LIVING OF SOUTHPORT
Authorized official EVIE MADERIOS - (ACCOUNTS RECEIVABLE MANAGER)
Entity Organization
Organization subpart No
Enumeration date 05/18/2007
Last updated 06/19/2008 - About 18 years ago
Sole proprietor1 Not specified
Identifiers
  • NC License #: HAL-068-023
  • NC Medicaid: 7805404

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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