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General NPI Number Information
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NPI Number | 1801006788
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Entity Type | Organization
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Legal Business Name | POOLE'S REST HOME
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 MARY JANE BIGELOW RD
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City | YANCEYVILLE
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State | NC
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Zip | 27379-9648
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Country | US
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Telephone | 336-694-5611
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1505
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City | YANCEYVILLE
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State | NC
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Zip | 27379-1505
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Country | US
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Telephone | 336-694-9288
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. GRACE POOLE
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Credential |
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Telephone | 336-694-9288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | HAL-017-006
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License Number State | NC
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