Provider Demographics
NPI:1629580204
Name:JMANOR LLR
Entity Type:Organization
Organization Name:JMANOR LLR
Other - Org Name:JMANOR SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-298-8439
Mailing Address - Street 1:140 BAY COLT RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30009-3529
Mailing Address - Country:US
Mailing Address - Phone:770-298-8439
Mailing Address - Fax:
Practice Address - Street 1:11905 HARRIS RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1113
Practice Address - Country:US
Practice Address - Phone:770-298-8439
Practice Address - Fax:770-298-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-02-046-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA060-02-046-1OtherPERSONAL CARE HOME LICENSE