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General NPI Number Information
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NPI Number | 1417087990
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Entity Type | Organization
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Legal Business Name | SOUTHERN MANOR REST HOME, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 521 DAVENPORT RD
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City | RUTHERFORDTON
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State | NC
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Zip | 28139
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Country | US
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Telephone | 909-894-9185
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 73
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City | COLLEGEDALE
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State | TN
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Zip | 37315-0073
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Country | US
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Telephone | 909-894-9185
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | SEUNG KWAN CHAI
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Credential |
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Telephone | 909-894-9185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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