Provider Demographics
NPI:1881819050
Name:ZOLLIEVILLE REST HOME NO2 INC
Entity Type:Organization
Organization Name:ZOLLIEVILLE REST HOME NO2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WARRENETTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-496-4170
Mailing Address - Street 1:1437 EAST RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-8584
Mailing Address - Country:US
Mailing Address - Phone:919-496-4170
Mailing Address - Fax:919-496-5639
Practice Address - Street 1:1437 EAST RIVER RD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-8584
Practice Address - Country:US
Practice Address - Phone:919-496-4170
Practice Address - Fax:919-496-5639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL035-014310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804990Medicaid