Provider Demographics
NPI:1538473400
Name:HICKORY MANOR
Entity Type:Organization
Organization Name:HICKORY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MECHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-324-5400
Mailing Address - Street 1:2530 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-7603
Mailing Address - Country:US
Mailing Address - Phone:828-324-5400
Mailing Address - Fax:828-326-9770
Practice Address - Street 1:2530 16TH ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-7603
Practice Address - Country:US
Practice Address - Phone:828-324-5400
Practice Address - Fax:828-326-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility