Provider Demographics
NPI:1659576239
Name:MANOR HOUSE COLLECTION, INC.
Entity Type:Organization
Organization Name:MANOR HOUSE COLLECTION, INC.
Other - Org Name:PENNYRICH BRA PATCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:DOWDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-876-8677
Mailing Address - Street 1:1603 N MARKET DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6259
Mailing Address - Country:US
Mailing Address - Phone:919-876-8677
Mailing Address - Fax:
Practice Address - Street 1:1603 N MARKET DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6259
Practice Address - Country:US
Practice Address - Phone:919-876-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6033290001Medicare NSC