Provider Demographics
NPI:1841241452
Name:THE MANOR
Entity Type:Organization
Organization Name:THE MANOR
Other - Org Name:SUMMIT HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-849-2151
Mailing Address - Street 1:115 EAST ST
Mailing Address - Street 2:P.O. BOX 98
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1007
Mailing Address - Country:US
Mailing Address - Phone:517-849-2151
Mailing Address - Fax:517-849-2880
Practice Address - Street 1:115 EAST ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1007
Practice Address - Country:US
Practice Address - Phone:517-849-2151
Practice Address - Fax:517-849-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6356654251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6757985Medicaid
MI6757985Medicaid