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Southern Ave Rest Home
Health Service Clinic/Center in Fayetteville, North Carolina
NPI 1083898589

Southern Ave Rest Home is a Health Service Clinic/Center based in Fayetteville, NC and is specialized in Health Service. Southern Ave Rest Home practices in Fayetteville, NC. The NPI Number for Southern Ave Rest Home is 1083898589 and holds a License No. FCL026012 (North Carolina).

The current practice location address for Southern Ave Rest Home is 1124 Southern Ave, Fayetteville, NC and can be reached out via phone at 910-286-8118.

Location: 1124 Southern Ave, Fayetteville, NC, 28306-1754
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1083898589
Provider Name
Southern Ave Rest Home
Credential
Provider Entity Type
Organization
Address
1124 Southern Ave, Fayetteville, NC, 28306-1754
Phone Number
910-286-8118
Fax Number
Provider Enumeration Date
12/20/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
78033383 05 NC
institution
Provider Business Practice Location Address Details
Address
1124 Southern Ave
City
Fayetteville
State
North Carolina
Zip
28306-1754
Phone Number
910-286-8118
Fax Number
person
Provider Business Mailing Address Details
Address
1124 Southern Ave
City
Fayetteville
State
North Carolina
Zip
28306-1754
Phone Number
910-286-8118
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Health Service
Taxonomy
261QH0100X
License No.
FCL026012 (North Carolina)
Definition
Definition to come...
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