=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063088540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REST ASSURED HOME HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2021
-----------------------------------------------------
Last Update Date | 06/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 627 WEST COUNCIL ST SUITE 304
-----------------------------------------------------
City | SALSIBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-918-0074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 WEST COUNCIL ST SUITE 304
-----------------------------------------------------
City | SALSIBURY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TRISHENA BOLT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-918-0074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------