Organization
PIGEON VALLEY REST HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY N LEATHERWOOD (ADMINISTRATOR)
(828) 648-2044
Entity
Organization
Contact information
Practice address
55 LAKE DR, CANTON, NC 28716-9312
(828) 648-2044
(828) 648-2065
Mailing address
100 SILVER BLUFF DR, CANTON, NC 28716-6350
(828) 648-2044
(828) 648-2065
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL044012
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7801751
—
NC
Enumeration date
08/31/2005
Last updated
08/22/2020
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