Provider Demographics
NPI:1457486474
Name:WHITE OAK MANOR INC
Entity Type:Organization
Organization Name:WHITE OAK MANOR INC
Other - Org Name:WHITE OAK MANOR ROCK HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-327-1162
Mailing Address - Street 1:PO BOX 3347
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-3347
Mailing Address - Country:US
Mailing Address - Phone:803-366-8155
Mailing Address - Fax:803-366-8158
Practice Address - Street 1:1915 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1013
Practice Address - Country:US
Practice Address - Phone:803-366-8155
Practice Address - Fax:803-366-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-885314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5260320001OtherNSC MEDICARE ID-PTAN
SC0459NHMedicaid
SC0255500009Medicare NSC
SC42-5088Medicare ID - Type UnspecifiedMEDICARE