Provider Demographics
NPI:1518084680
Name:BAR ENTERPRISES OF PERQUIMANS INC
Entity Type:Organization
Organization Name:BAR ENTERPRISES OF PERQUIMANS INC
Other - Org Name:RUSSELL'S REST HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-264-2055
Mailing Address - Street 1:117 GREGORYS LN
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-8878
Mailing Address - Country:US
Mailing Address - Phone:252-264-2055
Mailing Address - Fax:
Practice Address - Street 1:117 GREGORYS LN
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-8878
Practice Address - Country:US
Practice Address - Phone:252-264-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAR ENTERPRISES OF PERQUIMANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7801482310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility