Provider Demographics
NPI:1669529996
Name:THE HOMEPLACE REST & RETIREMENT
Entity type:Organization
Organization Name:THE HOMEPLACE REST & RETIREMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:704-982-9700
Mailing Address - Street 1:42912 VICKERS STORE RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-8646
Mailing Address - Country:US
Mailing Address - Phone:704-982-9700
Mailing Address - Fax:980-581-3128
Practice Address - Street 1:42912 VICKERS STORE RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8646
Practice Address - Country:US
Practice Address - Phone:704-982-9700
Practice Address - Fax:980-581-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-084-007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility