Provider Demographics
NPI:1407220502
Name:MANIFEST TOTAL CARE
Entity Type:Organization
Organization Name:MANIFEST TOTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNTAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-300-5112
Mailing Address - Street 1:3001 QUARTER CREEK LN
Mailing Address - Street 2:#4
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5215
Mailing Address - Country:US
Mailing Address - Phone:804-300-5664
Mailing Address - Fax:
Practice Address - Street 1:3001 QUARTER CREEK LN
Practice Address - Street 2:#4
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-5215
Practice Address - Country:US
Practice Address - Phone:804-300-5664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based