Provider Demographics
NPI:1619015773
Name:ROSEMONT REST HOME INC.
Entity Type:Organization
Organization Name:ROSEMONT REST HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUJAHED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-318-9667
Mailing Address - Street 1:PO BOX 2804
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-2804
Mailing Address - Country:US
Mailing Address - Phone:910-318-9667
Mailing Address - Fax:910-276-9223
Practice Address - Street 1:602 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-6724
Practice Address - Country:US
Practice Address - Phone:910-318-9667
Practice Address - Fax:910-276-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-078-020311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804164Medicaid