Provider Demographics
NPI:1962480186
Name:MARANATHA MANOR OF SPARTANBURG, INC
Entity Type:Organization
Organization Name:MARANATHA MANOR OF SPARTANBURG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-579-0086
Mailing Address - Street 1:2902 E MAIN STREET EXT
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1252
Mailing Address - Country:US
Mailing Address - Phone:864-579-0086
Mailing Address - Fax:864-579-0466
Practice Address - Street 1:2902 E MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1252
Practice Address - Country:US
Practice Address - Phone:864-579-0086
Practice Address - Fax:864-579-0466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC1235310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRC1235Medicaid