Provider Demographics
NPI:1700054384
Name:STANLY MANOR
Entity Type:Organization
Organization Name:STANLY MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRIN-HUNEYCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-982-0770
Mailing Address - Street 1:625 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-8523
Mailing Address - Country:US
Mailing Address - Phone:704-982-0770
Mailing Address - Fax:704-982-1014
Practice Address - Street 1:625 BETHANY RD
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8523
Practice Address - Country:US
Practice Address - Phone:704-982-0770
Practice Address - Fax:704-982-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0464314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3406495Medicaid