MEDICARE: COUNTRY REST HOME, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	1176	DE

General Provider Information

NPI Number	:	1447477690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY REST HOME, INC.

Provider Business Mailing Address
First Line	:	12046 SUNSET LN
Second Line	:
City	:	GREENWOOD
State	:	DE
Zip	:	19950-4867
Country	:	US
Telephone Number	:	302-349-4114
Fax Number	:	302-349-4684

Provider Business Practice Location Address
First Line	:	12046 SUNSET LN
Second Line	:
City	:	GREENWOOD
State	:	DE
Zip	:	19950-4867
Country	:	US
Telephone Number	:	302-349-4114
Fax Number	:	302-349-4684

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	BEKA TROYER
Credential	:
Telephone Number	:	302-349-4114

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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Directions to “COUNTRY REST HOME, INC. ” Practice Location

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