Provider Demographics
NPI:1649618927
Name:PARK MANOR LTD
Entity type:Organization
Organization Name:PARK MANOR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-762-2449
Mailing Address - Street 1:250 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1431
Mailing Address - Country:US
Mailing Address - Phone:715-762-2449
Mailing Address - Fax:715-762-3321
Practice Address - Street 1:250 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1431
Practice Address - Country:US
Practice Address - Phone:715-762-2449
Practice Address - Fax:715-762-3321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK MANOR LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory