Provider Demographics
NPI:1184600843
Name:DURHAM MANOR, LLC
Entity type:Organization
Organization Name:DURHAM MANOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-578-6599
Mailing Address - Street 1:3720 BOILING SPRINGS RD
Mailing Address - Street 2:SUITE F, PMB 103
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-5716
Mailing Address - Country:US
Mailing Address - Phone:864-578-6599
Mailing Address - Fax:864-814-1198
Practice Address - Street 1:5935 MOUNT SINAI RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-8616
Practice Address - Country:US
Practice Address - Phone:864-578-6599
Practice Address - Fax:864-814-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0093310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7805846Medicaid
NC3446018Medicaid
NC3435346Medicaid
NC6009360001Medicare NSC
NC3435346Medicaid