Healthcare Provider Details

I. General information

NPI: 1881819050
Provider Name (Legal Business Name): ZOLLIEVILLE REST HOME NO2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 EAST RIVER RD
LOUISBURG NC
27549-8584
US

IV. Provider business mailing address

1437 EAST RIVER RD
LOUISBURG NC
27549-8584
US

V. Phone/Fax

Practice location:
  • Phone: 919-496-4170
  • Fax: 919-496-5639
Mailing address:
  • Phone: 919-496-4170
  • Fax: 919-496-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL035-014
License Number StateNC

VIII. Authorized Official

Name: MRS. WARRENETTA M STEVENSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-496-4170