Provider Demographics
NPI:1700022241
Name:SUMMER MANOR
Entity Type:Organization
Organization Name:SUMMER MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-524-8260
Mailing Address - Street 1:PO BOX 37730
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27627-7730
Mailing Address - Country:US
Mailing Address - Phone:919-851-3715
Mailing Address - Fax:919-460-9448
Practice Address - Street 1:9904 BAILEYWICK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6201
Practice Address - Country:US
Practice Address - Phone:919-851-3715
Practice Address - Fax:919-460-9448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-092-136311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home