34D2017449 CLIA NUMBER - B & J REST VILLA DBA WAYNE CO REST VILLA

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Laboratory Demographics

CLIA Number: 34D2017449

Facility Name: B & J REST VILLA DBA WAYNE CO REST VILLA

Facility Address:
305 VANCE STREET
FREMONT, NC
ZIP 27830
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Facility Phone Number: 919 242-6147

Facility Type: Other - ADULT CARE HOME

Certificate Type: Waiver

NPI Number: 1275676561

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	34D2017449
LAB Type	Other - ADULT CARE HOME
Facility Name	B & J REST VILLA DBA WAYNE CO REST VILLA
Street	305 VANCE STREET
City	FREMONT
State	NC
ZIP	27830
Phone	919 242-6147
CertificateType	4
CertificateEffectiveDate	12/13/2022
CertificateExpirationDate	12/12/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024