# SOUTHERN MANOR REST HOME, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417087990
- **Authorized official:** SEUNG KWAN CHAI (PRESIDENT/ADMINISTRATOR)
- **Authorized official phone:** (909) 894-9185

## Contact information

- **Practice address:** 521 DAVENPORT RD, RUTHERFORDTON, NC 28139
- **Practice address phone:** (909) 894-9185
- **Mailing address:** PO BOX 73, COLLEGEDALE, TN 37315-0073
- **Mailing address phone:** (909) 894-9185

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/06/2007
- **Last updated:** 12/13/2024