Leaksville Rest Home, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-079-096 Issued in NC

Legal business name

LEAKSVILLE REST HOME, LLC

Practice address

915 Irving Ave
Eden, NC 27288-5509

Phone

(336) 280-5637

Fax

(336) 635-9004

NPI assigned

Apr 25, 2014

Organization subpart

No

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

Authorized official

Name

Pamela Arthur Clark

Title

Sole Member Manager/Administrator

Phone

(336) 280-5637

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1398384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398384000000",
    "number": "1285054593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 IRVING AVE",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885509",
            "telephone_number": "336-280-5637",
            "fax_number": "336-635-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 IRVING AVE",
            "city": "EDEN",
            "state": "NC",
            "postal_code": "272885509",
            "telephone_number": "336-280-5637",
            "fax_number": "336-635-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAKSVILLE REST HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-25",
        "last_updated": "2014-04-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "ARTHUR",
        "authorized_official_title_or_position": "SOLE MEMBER MANAGER/ADMINISTRATOR",
        "authorized_official_telephone_number": "336-280-5637"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-079-096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Layne'S Family Pharmacy, Inc.
• Layne'S Family Pharmacy, Inc.
• Laynecare LLC
• Laynes Family Pharmacy
• Leaksville Rest Home #2
• Okafor Mang Lekwuwa, MD
• John Lesueur, D.C.
• Felicia Lewis
• Jacqueline Lenore Lewis, RN
• Kimberly Hines Lewis, COTA/L

• Adult Care Home Facility in Eden, NC
• Providers in Eden, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2014; 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.