MEDICARE: ZOLLIEVILLE REST HOME NO2 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	HAL035-014	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	:	1881819050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZOLLIEVILLE REST HOME NO2 INC

Provider Business Mailing Address
First Line	:	1437 EAST RIVER RD
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-8584
Country	:	US
Telephone Number	:	919-496-4170
Fax Number	:	919-496-5639

Provider Business Practice Location Address
First Line	:	1437 EAST RIVER RD
Second Line	:
City	:	LOUISBURG
State	:	NC
Zip	:	27549-8584
Country	:	US
Telephone Number	:	919-496-4170
Fax Number	:	919-496-5639

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. WARRENETTA M STEVENSON
Credential	:
Telephone Number	:	919-496-4170

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/16/2008

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