Provider Demographics
NPI:1457471948
Name:CAGLES REST HOME
Entity Type:Organization
Organization Name:CAGLES REST HOME
Other - Org Name:POPLAR SPRINGS REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-428-4350
Mailing Address - Street 1:601 DOVER RD
Mailing Address - Street 2:PO BOX 400
Mailing Address - City:STAR
Mailing Address - State:NC
Mailing Address - Zip Code:27356-7772
Mailing Address - Country:US
Mailing Address - Phone:910-428-4350
Mailing Address - Fax:910-428-4376
Practice Address - Street 1:601 DOVER RD
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-7772
Practice Address - Country:US
Practice Address - Phone:910-428-4350
Practice Address - Fax:910-428-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL062003376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty