Provider Demographics
NPI:1881724342
Name:FREMONT REST CENTER
Entity type:Organization
Organization Name:FREMONT REST CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-643-0555
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-0878
Mailing Address - Country:US
Mailing Address - Phone:336-643-0555
Mailing Address - Fax:336-643-0553
Practice Address - Street 1:300 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NC
Practice Address - Zip Code:27830
Practice Address - Country:US
Practice Address - Phone:919-242-6161
Practice Address - Fax:919-242-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-096-024310400000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804344Medicaid