Provider Demographics
NPI:1407993413
Name:ROSEMARY REST HOME, INC.
Entity Type:Organization
Organization Name:ROSEMARY REST HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:W
Authorized Official - Last Name:CASTEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-289-2435
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28458-0928
Mailing Address - Country:US
Mailing Address - Phone:910-289-2435
Mailing Address - Fax:910-289-2450
Practice Address - Street 1:571 SOUTH SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:NC
Practice Address - Zip Code:28458-0928
Practice Address - Country:US
Practice Address - Phone:910-289-2435
Practice Address - Fax:910-289-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 031-008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801803Medicaid