Provider Demographics
NPI:1871683524
Name:MANOR RESPIRATORY CARE, INC.
Entity Type:Organization
Organization Name:MANOR RESPIRATORY CARE, INC.
Other - Org Name:MANOR HEALTHCARE SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-773-1596
Mailing Address - Street 1:PO BOX 1396
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37121-1396
Mailing Address - Country:US
Mailing Address - Phone:615-773-1596
Mailing Address - Fax:615-754-2582
Practice Address - Street 1:2913 FOX CHASE LANE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-595-0617
Practice Address - Fax:804-595-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009355332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5447270002Medicare NSC