Provider Demographics
NPI:1376671024
Name:LATRELLS ENTERPRISE
Entity Type:Organization
Organization Name:LATRELLS ENTERPRISE
Other - Org Name:BLACKWELL'S REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-421-9665
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:YANCEYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27379-0778
Mailing Address - Country:US
Mailing Address - Phone:336-694-7785
Mailing Address - Fax:336-694-7786
Practice Address - Street 1:3782 CHERRY GROVE RD
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9484
Practice Address - Country:US
Practice Address - Phone:336-421-9488
Practice Address - Fax:336-421-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-017-001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility