Provider Demographics
NPI:1720290547
Name:SPRING VILLAGE REST HOME INC
Entity Type:Organization
Organization Name:SPRING VILLAGE REST HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-5445
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0472
Mailing Address - Country:US
Mailing Address - Phone:910-865-5445
Mailing Address - Fax:910-865-5445
Practice Address - Street 1:508 WORTH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-0472
Practice Address - Country:US
Practice Address - Phone:910-865-5445
Practice Address - Fax:910-865-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL078016310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility