Provider Demographics
NPI:1144749037
Name:INTEGRITY - DIXIE OAK MANOR, LLC
Entity Type:Organization
Organization Name:INTEGRITY - DIXIE OAK MANOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SWAIN
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-438-1383
Mailing Address - Street 1:4900 KOGER BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2738
Mailing Address - Country:US
Mailing Address - Phone:336-438-1376
Mailing Address - Fax:336-438-1387
Practice Address - Street 1:6410 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-5909
Practice Address - Country:US
Practice Address - Phone:772-569-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL8502310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility