Provider Demographics
NPI:1487062311
Name:CARRIE DOUGLAS
Entity type:Organization
Organization Name:CARRIE DOUGLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:SIMONS
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-287-0180
Mailing Address - Street 1:1439 US HIGHWAY 13 S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-8125
Mailing Address - Country:US
Mailing Address - Phone:252-513-8120
Mailing Address - Fax:252-358-5068
Practice Address - Street 1:1439 US HIGHWAY 13 S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8125
Practice Address - Country:US
Practice Address - Phone:252-513-8120
Practice Address - Fax:252-358-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility