Provider Demographics
NPI:1235269952
Name:ATWATER REST HOME INC.
Entity Type:Organization
Organization Name:ATWATER REST HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-362-6266
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:312 LYNCH ST.
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-0942
Mailing Address - Country:US
Mailing Address - Phone:919-362-6266
Mailing Address - Fax:919-362-6298
Practice Address - Street 1:312 LYNCH ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2028
Practice Address - Country:US
Practice Address - Phone:919-362-6266
Practice Address - Fax:919-362-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-092-122310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility