Poole's Rest Home

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

HAL-017-006 Issued in NC

Legal business name

POOLE'S REST HOME

Practice address

201 Mary Jane Bigelow Rd
Yanceyville, NC 27379-9648

Phone

(336) 694-5611

NPI assigned

May 22, 2007

Last updated

Aug 22, 2020By 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

Mrs. Grace Poole

Title

Administrator

Phone

(336) 694-9288

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801006788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1505",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273791505",
            "telephone_number": "336-694-9288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 MARY JANE BIGELOW RD",
            "city": "YANCEYVILLE",
            "state": "NC",
            "postal_code": "273799648",
            "telephone_number": "336-694-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOLE'S REST HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POOLE",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-694-9288",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "NC",
            "license": "HAL-017-006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804039",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Yanceyville, NC
• Providers in Yanceyville, NC by specialty
• Assisted Living Facility (Mental Illness) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.