Provider Demographics
NPI:1437609948
Name:MERCY MANOR AT SAYBROOKE, INC
Entity Type:Organization
Organization Name:MERCY MANOR AT SAYBROOKE, INC
Other - Org Name:MERCY MANOR, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:CHINAKA
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:919-271-0917
Mailing Address - Street 1:2804 TREVI FOUNTAIN PLACE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-878-1912
Mailing Address - Fax:919-790-9970
Practice Address - Street 1:6320 SAYBROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604
Practice Address - Country:US
Practice Address - Phone:919-878-1912
Practice Address - Fax:919-790-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-221311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home