Provider Demographics
NPI:1215183884
Name:MANCHESTER MANOR, INC.
Entity Type:Organization
Organization Name:MANCHESTER MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-725-8390
Mailing Address - Street 1:12 MANCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2016
Mailing Address - Country:US
Mailing Address - Phone:401-725-8390
Mailing Address - Fax:401-725-1359
Practice Address - Street 1:12 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2016
Practice Address - Country:US
Practice Address - Phone:401-725-8390
Practice Address - Fax:401-725-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIALR01315310400000X, 3104A0625X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances