Provider Demographics
NPI:1790024529
Name:GARRISON MANOR, LLC
Entity Type:Organization
Organization Name:GARRISON MANOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-360-9806
Mailing Address - Street 1:1414 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-3723
Mailing Address - Country:US
Mailing Address - Phone:252-360-9806
Mailing Address - Fax:252-210-2967
Practice Address - Street 1:1414 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-3723
Practice Address - Country:US
Practice Address - Phone:252-360-9806
Practice Address - Fax:252-210-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL 033-008311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home