Provider Demographics
NPI:1518111616
Name:REST ASSURE FAMILY CARE HOME
Entity Type:Organization
Organization Name:REST ASSURE FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MECHELLE
Authorized Official - Last Name:ELLERBEE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:910-844-6304
Mailing Address - Street 1:606 CORRELL ST
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-2616
Mailing Address - Country:US
Mailing Address - Phone:910-844-6304
Mailing Address - Fax:
Practice Address - Street 1:405 WEST MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-1866
Practice Address - Country:US
Practice Address - Phone:910-844-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-078-069310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility