Provider Demographics
NPI:1558464750
Name:THE BAPTIST MANOR
Entity Type:Organization
Organization Name:THE BAPTIST MANOR
Other - Org Name:THE MANOR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CPO/CSO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-304-8657
Mailing Address - Street 1:10095 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5428
Mailing Address - Country:US
Mailing Address - Phone:850-479-4000
Mailing Address - Fax:
Practice Address - Street 1:10095 HILLVIEW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5428
Practice Address - Country:US
Practice Address - Phone:850-479-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1030095314000000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN04OtherBCBS FLORIDA
105532Medicare ID - Type Unspecified
FLN04OtherBCBS FLORIDA