Provider Demographics
NPI:1609966654
Name:HELMS REST HOME
Entity type:Organization
Organization Name:HELMS REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-843-2472
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:210 MC CAIN ST
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-1038
Mailing Address - Country:US
Mailing Address - Phone:704-843-2472
Mailing Address - Fax:704-843-2555
Practice Address - Street 1:210 MCCAIN ST
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-1038
Practice Address - Country:US
Practice Address - Phone:704-843-2472
Practice Address - Fax:704-843-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCH-90-010310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803123Medicaid