Provider Demographics
NPI:1851162390
Name:VARNUM'S REST HOME, LLC
Entity Type:Organization
Organization Name:VARNUM'S REST HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-643-5155
Mailing Address - Street 1:12167 NW FREEMAN RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12167 NW FREEMAN RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3019
Practice Address - Country:US
Practice Address - Phone:850-643-5155
Practice Address - Fax:850-643-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility