Provider Demographics
NPI:1265551394
Name:FAIRVIEW REST HOME
Entity type:Organization
Organization Name:FAIRVIEW REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-879-9510
Mailing Address - Street 1:2760 ICARD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CONNELLYS SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612-7705
Mailing Address - Country:US
Mailing Address - Phone:828-879-9510
Mailing Address - Fax:828-879-2040
Practice Address - Street 1:2760 ICARD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONNELLYS SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-7705
Practice Address - Country:US
Practice Address - Phone:828-879-9510
Practice Address - Fax:828-879-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL012006311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7802325Medicaid