Provider Demographics
NPI:1356460406
Name:CARVER MANOR
Entity Type:Organization
Organization Name:CARVER MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAITOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-398-4468
Mailing Address - Street 1:208 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-9361
Mailing Address - Country:US
Mailing Address - Phone:252-398-4468
Mailing Address - Fax:252-398-4468
Practice Address - Street 1:208 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-9361
Practice Address - Country:US
Practice Address - Phone:252-398-4468
Practice Address - Fax:252-398-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-O46-002311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124078878Medicaid
VANPIMedicaid
VANPIMedicaid