MEDICARE: THE ROSSBERRY HOME OF FAIRMONT, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1851501001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROSSBERRY HOME OF FAIRMONT, INC.

Provider Business Mailing Address
First Line	:	950 LANE ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28083-3748
Country	:	US
Telephone Number	:	704-933-3314
Fax Number	:	704-933-3320

Provider Business Practice Location Address
First Line	:	429 PERSON ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-5737
Country	:	US
Telephone Number	:	910-483-8841
Fax Number	:	910-483-9198

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. GLORIA J. ROSS
Credential	:	RN
Telephone Number	:	704-933-3314

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	08/22/2020

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