Healthcare Provider Details

I. General information

NPI: 1407993413
Provider Name (Legal Business Name): ROSEMARY REST HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 SOUTH SYCAMORE ST
ROSE HILL NC
28458-0928
US

IV. Provider business mailing address

PO BOX 928
ROSE HILL NC
28458-0928
US

V. Phone/Fax

Practice location:
  • Phone: 910-289-2435
  • Fax: 910-289-2450
Mailing address:
  • Phone: 910-289-2435
  • Fax: 910-289-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL 031-008
License Number StateNC

VIII. Authorized Official

Name: SHANNON W CASTEEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 910-289-2435