Provider Demographics
NPI:1477857894
Name:QUAIL & MANNA, INC
Entity Type:Organization
Organization Name:QUAIL & MANNA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EWANDRA
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-332-2588
Mailing Address - Street 1:2019 THRIFT RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4450
Mailing Address - Country:US
Mailing Address - Phone:704-332-2588
Mailing Address - Fax:704-332-2587
Practice Address - Street 1:2019 THRIFT RD
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4450
Practice Address - Country:US
Practice Address - Phone:704-332-2588
Practice Address - Fax:704-332-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100161608251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418942Medicaid