MEDICARE: SLAY' REST HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	HAL 060-038	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407047343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLAY' REST HOME

Provider Business Mailing Address
First Line	:	2920 CINDY LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4213
Country	:	US
Telephone Number	:	704-596-8401
Fax Number	:	704-596-8401

Provider Business Practice Location Address
First Line	:	2920 CINDY LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-4213
Country	:	US
Telephone Number	:	704-509-9132
Fax Number	:	704-596-8401

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PHYLLIS MILLER SLAY
Credential	:
Telephone Number	:	704-596-8401

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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Directions to “SLAY' REST HOME ” Practice Location

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