Provider Demographics
NPI:1801037247
Name:MILTON'S MANOR
Entity Type:Organization
Organization Name:MILTON'S MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HERMENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-279-1192
Mailing Address - Street 1:1607 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-2423
Mailing Address - Country:US
Mailing Address - Phone:336-279-1192
Mailing Address - Fax:336-279-1192
Practice Address - Street 1:1607 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2423
Practice Address - Country:US
Practice Address - Phone:336-279-1192
Practice Address - Fax:336-279-1192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL0418353104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness