Provider Demographics
NPI:1184044455
Name:CHARLENE MANOR
Entity Type:Organization
Organization Name:CHARLENE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARONAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-774-3724
Mailing Address - Street 1:150 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-9605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 COLRAIN RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9625
Practice Address - Country:US
Practice Address - Phone:413-774-3724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1668314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility