Provider Demographics
NPI:1356462063
Name:MOYER REST HOME
Entity Type:Organization
Organization Name:MOYER REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-427-4962
Mailing Address - Street 1:5767 HWY 135
Mailing Address - Street 2:
Mailing Address - City:STONEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27048
Mailing Address - Country:US
Mailing Address - Phone:336-427-4962
Mailing Address - Fax:336-427-4965
Practice Address - Street 1:5765HWY 135
Practice Address - Street 2:
Practice Address - City:STONEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27048
Practice Address - Country:US
Practice Address - Phone:336-427-4962
Practice Address - Fax:336-427-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility