Provider Demographics
NPI:1942857289
Name:WRIGHT MANOR
Entity Type:Organization
Organization Name:WRIGHT MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DORINDA
Authorized Official - Middle Name:JENIPHER
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-276-1778
Mailing Address - Street 1:2550 SANDLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8928
Mailing Address - Country:US
Mailing Address - Phone:904-891-8793
Mailing Address - Fax:
Practice Address - Street 1:2550 SANDLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8928
Practice Address - Country:US
Practice Address - Phone:904-891-8793
Practice Address - Fax:904-621-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility