Green Manor Rest Home, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

HAL-078-003 Issued in NC

Legal business name

GREEN MANOR REST HOME, INC.

Practice address

1083 West Parkton Tobemory Road
Parkton, NC 28371

Phone

(910) 858-3005

NPI assigned

Dec 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Zeddie Beebe Green

Title

President

Phone

(910) 858-3826

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1198454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198454400000",
    "number": "1578747762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "PARKTON",
            "state": "NC",
            "postal_code": "283710299",
            "telephone_number": "910-858-3826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1083 WEST PARKTON TOBEMORY ROAD",
            "city": "PARKTON",
            "state": "NC",
            "postal_code": "28371",
            "telephone_number": "910-858-3005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN MANOR REST HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-24",
        "last_updated": "2007-12-24",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "ZEDDIE",
        "authorized_official_middle_name": "BEEBE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-858-3826",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL-078-003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7801957",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Parkton, NC
• Providers in Parkton, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 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.