Southern Ave Rest Home

LBN: Southern Ave Rest Home
Southern Ave Rest Home is an health care organization with primary practice located at 1124 Southern Ave , Fayetteville NC 28306-1754. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Southern Ave Rest Home can be contacted via phone (910) 286-8118, or through Jones, Neill via phone (910) 484-4291.

Contact Information

Primary practice address
1124 Southern Ave Fayetteville NC 28306-1754
Phone: (910) 286-8118
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Jones, Neill
Phone: (910) 484-4291

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X FCL026012 North Carolina

Profile Details

NPI number 1083898589
LBN Legal business name Southern Ave Rest Home
DBA Doing business as
Authorized official Jones, Neill
Entity Organization
Organization subpart 1 No
Enumeration date Dec 20th, 2007
Last updated Dec 20th, 2007 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083898589 NPPES
North Carolina MEDICAID 78033383

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