Healthcare Provider Details

I. General information

NPI: 1679776363
Provider Name (Legal Business Name): JAMES REST HOME , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 JAMES REST HOME RD
NEW HILL NC
27562-0070
US

IV. Provider business mailing address

PO BOX 70
NEW HILL NC
27562-0070
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-8856
  • Fax: 919-362-4507
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHAL-092-007
License Number StateNC

VIII. Authorized Official

Name: EDYTHE JAMES- MCMILLAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-362-8856