Organization
LEAKSVILLE REST HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA ARTHUR CLARK (SOLE MEMBER MANAGER/ADMINISTRATOR)
(336) 280-5637
Entity
Organization
Contact information
Practice address
915 IRVING AVE, EDEN, NC 27288-5509
(336) 280-5637
(336) 635-9004
Mailing address
915 IRVING AVE, EDEN, NC 27288-5509
(336) 280-5637
(336) 635-9004
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-079-096
NC
Other
Enumeration date
04/25/2014
Last updated
04/25/2014
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