Provider Demographics
NPI:1487044350
Name:HAMPTONMANOR,LLC
Entity Type:Organization
Organization Name:HAMPTONMANOR,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-261-2988
Mailing Address - Street 1:3546 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1613
Mailing Address - Country:US
Mailing Address - Phone:619-261-2988
Mailing Address - Fax:
Practice Address - Street 1:3546 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1613
Practice Address - Country:US
Practice Address - Phone:619-261-2988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCFE374603181320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness