Provider Demographics
NPI:1639290828
Name:LONGS REST HOME III
Entity Type:Organization
Organization Name:LONGS REST HOME III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-272-3466
Mailing Address - Street 1:317 OCONNOR ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-2209
Mailing Address - Country:US
Mailing Address - Phone:336-272-3466
Mailing Address - Fax:336-855-0487
Practice Address - Street 1:317 OCONNOR ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2209
Practice Address - Country:US
Practice Address - Phone:336-272-3466
Practice Address - Fax:336-855-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility