MEDICARE: JAMES 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	310400000X	Assisted Living Facility	HAL-092-007	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679776363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES REST HOME , INC

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-0070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8420 JAMES REST HOME RD
Second Line	:
City	:	NEW HILL
State	:	NC
Zip	:	27562-0070
Country	:	US
Telephone Number	:	919-362-8856
Fax Number	:	919-362-4507

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EDYTHE JAMES- MCMILLAN
Credential	:
Telephone Number	:	919-362-8856

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	08/22/2020

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