Provider Demographics
NPI:1447588629
Name:DAVCO REST HOME, LLC
Entity Type:Organization
Organization Name:DAVCO REST HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:270-683-5571
Mailing Address - Street 1:7 WOODFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-0563
Mailing Address - Country:US
Mailing Address - Phone:270-683-5571
Mailing Address - Fax:270-683-8317
Practice Address - Street 1:2526 W 10TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-1738
Practice Address - Country:US
Practice Address - Phone:270-684-1705
Practice Address - Fax:270-684-0963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVCO HOMES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
100084310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility