Organization
PINE FOREST REST, INC
Active
Organization
PINE FOREST REST, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA JOHNSON TAYLOR LPN, ADMINISTRATOR (ADMINISTRATOR)
(252) 587-1591
Entity
Organization
Contact information
Practice address
3277 NC 35, POTECASI, NC 27867-0067
(252) 587-1591
(252) 587-1196
Mailing address
PO BOX 67, POTECASI, NC 27867-0067
(252) 587-1591
(252) 587-1196
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
HAL-066-001
NC
Other
Enumeration date
12/26/2007
Last updated
12/26/2007
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