Provider Demographics
NPI:1336287077
Name:MANNING GARDENS CARE CENTER INC
Entity Type:Organization
Organization Name:MANNING GARDENS CARE CENTER INC
Other - Org Name:MANNING GARDENS NURSING AND REHAB INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNERSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-972-7292
Mailing Address - Street 1:2113 E MANNING AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9681
Mailing Address - Country:US
Mailing Address - Phone:559-834-2586
Mailing Address - Fax:559-834-2540
Practice Address - Street 1:2113 E MANNING AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93725-9681
Practice Address - Country:US
Practice Address - Phone:559-834-2586
Practice Address - Fax:559-834-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000119314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR05423FMedicaid
CA05-5423Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER