Southern Ave Rest Home

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

FCL026012 Issued in NC

Legal business name

SOUTHERN AVE REST HOME

Practice address

1124 Southern Ave
Fayetteville, NC 28306-1754

Phone

(910) 286-8118

NPI assigned

Dec 20, 2007

Last updated

Dec 20, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Neill Jones

Title

Owner

Phone

(910) 484-4291

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1083898589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 SOUTHERN AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283061754",
            "telephone_number": "910-286-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 SOUTHERN AVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283061754",
            "telephone_number": "910-286-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN AVE REST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "NEILL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-484-4291",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NC",
            "license": "FCL026012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78033383",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeastern Communication and Swallowing Specialists
• Southeastern Communication and Swallowing Specialists
• Southeastern Home Care, LLC
• Southeastern Motor and Sensory Specialists
• Southeastern Radiation Oncology
• Southern Family Markets LLC (Southern Family Market)
• Southern Healthcare Network
• Southern Hospitality Home Support Care
• Southern Internal Medicine, PC
• Amy E. Southworth

• Health Service Clinic/Center in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Health Service Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.