# INDIGO CAROLINA FOREST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992563597
- **Authorized official:** MARISA STRAIN RN (CCO)
- **Authorized official phone:** (850) 712-5566

## Contact information

- **Practice address:** 176 VILLAGE CENTER BLVD, MYRTLE BEACH, SC 29579-5622
- **Practice address phone:** (850) 712-5566
- **Mailing address:** 2573 BARRINGTON CIR, TALLAHASSEE, FL 32308-6805
- **Mailing address phone:** (850) 712-5566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/08/2024
- **Last updated:** 03/25/2024