Provider Demographics
NPI:1689390460
Name:HERTFORD MANOR
Entity Type:Organization
Organization Name:HERTFORD MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NWANKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-532-9707
Mailing Address - Street 1:464 TWO MILE DESERT RD
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-8686
Mailing Address - Country:US
Mailing Address - Phone:252-404-0248
Mailing Address - Fax:252-404-0245
Practice Address - Street 1:464 TWO MILE DESERT RD
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-8686
Practice Address - Country:US
Practice Address - Phone:252-404-0248
Practice Address - Fax:252-404-0245
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIOLA VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home