Provider Demographics
NPI:1184057390
Name:CARILLON ASSISTED LIVING OF MOORESVILLE LLC
Entity type:Organization
Organization Name:CARILLON ASSISTED LIVING OF MOORESVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-852-4000
Mailing Address - Street 1:4901 WATERS EDGE DR STE 200
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:
Practice Address - Street 1:198 E WATERLYNN RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8074
Practice Address - Country:US
Practice Address - Phone:704-660-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARILLON ASSISTED LIVING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility