Provider Demographics
NPI:1649268335
Name:SMITHFIELD MANOR, INC.
Entity type:Organization
Organization Name:SMITHFIELD MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ARNN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:919-934-3171
Mailing Address - Street 1:PO BOX 1940
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-1940
Mailing Address - Country:US
Mailing Address - Phone:919-934-3171
Mailing Address - Fax:919-934-5960
Practice Address - Street 1:902 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4731
Practice Address - Country:US
Practice Address - Phone:919-934-3171
Practice Address - Fax:919-934-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0182314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3415175Medicaid
NC00939OtherBLUE CROSS BLUE SHIELD
NC00939OtherBLUE CROSS BLUE SHIELD