Provider Demographics
NPI:1316004245
Name:YANCEY REST HOME INC
Entity Type:Organization
Organization Name:YANCEY REST HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DURHAM
Authorized Official - Last Name:ISLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:919-732-3551
Mailing Address - Street 1:401 N CHURTON ST
Mailing Address - Street 2:PO BOX 729
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-2126
Mailing Address - Country:US
Mailing Address - Phone:919-732-3551
Mailing Address - Fax:919-732-3551
Practice Address - Street 1:401 N CHURTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2126
Practice Address - Country:US
Practice Address - Phone:919-732-3551
Practice Address - Fax:919-732-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL068005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803475Medicaid