Provider Demographics
NPI:1407047343
Name:SLAY' REST HOME
Entity Type:Organization
Organization Name:SLAY' REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:MILLER
Authorized Official - Last Name:SLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-596-8401
Mailing Address - Street 1:2920 CINDY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4213
Mailing Address - Country:US
Mailing Address - Phone:704-596-8401
Mailing Address - Fax:704-596-8401
Practice Address - Street 1:2920 CINDY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4213
Practice Address - Country:US
Practice Address - Phone:704-509-9132
Practice Address - Fax:704-596-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 060-038261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803805Medicaid