Provider Demographics
NPI:1689795411
Name:FANNIE NORWOOD MEMORIAL REST HOME
Entity Type:Organization
Organization Name:FANNIE NORWOOD MEMORIAL REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARARET
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-0209
Mailing Address - Street 1:501 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5536
Mailing Address - Country:US
Mailing Address - Phone:910-762-0209
Mailing Address - Fax:910-762-1069
Practice Address - Street 1:501 S 15TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5536
Practice Address - Country:US
Practice Address - Phone:910-762-0209
Practice Address - Fax:910-762-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility