Provider Demographics
NPI:1184451064
Name:MONROE MANOR ASSISTED LIVING II INC
Entity type:Organization
Organization Name:MONROE MANOR ASSISTED LIVING II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:843-672-4019
Mailing Address - Street 1:1101 BAUCOM RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7584
Mailing Address - Country:US
Mailing Address - Phone:843-672-4019
Mailing Address - Fax:704-270-6138
Practice Address - Street 1:1101 BAUCOM RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7584
Practice Address - Country:US
Practice Address - Phone:843-672-4019
Practice Address - Fax:704-270-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty