Provider Demographics
NPI:1134250293
Name:PRIDDY MANOR LLC
Entity type:Organization
Organization Name:PRIDDY MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-983-3068
Mailing Address - Street 1:1294 PRIDDY RD
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-7485
Mailing Address - Country:US
Mailing Address - Phone:336-983-3068
Mailing Address - Fax:336-983-0681
Practice Address - Street 1:1294 PRIDDY RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-7485
Practice Address - Country:US
Practice Address - Phone:336-983-3068
Practice Address - Fax:336-983-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility