Provider Demographics
NPI:1629279724
Name:SPRING ROAD REST HOME
Entity Type:Organization
Organization Name:SPRING ROAD REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMONA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-441-7947
Mailing Address - Street 1:4109 SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-6710
Mailing Address - Country:US
Mailing Address - Phone:828-441-7947
Mailing Address - Fax:828-441-9974
Practice Address - Street 1:4109 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-6710
Practice Address - Country:US
Practice Address - Phone:828-441-7947
Practice Address - Fax:828-441-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL018006310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803907Medicaid
FCL 018006OtherNC DHHS UNCENSE NUMBER