Provider Demographics
NPI:1700078110
Name:MARANATHA MANOR INC.
Entity Type:Organization
Organization Name:MARANATHA MANOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:VAN KLEECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-471-2766
Mailing Address - Street 1:54 MARANATHA BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-6818
Mailing Address - Country:US
Mailing Address - Phone:863-471-2766
Mailing Address - Fax:863-471-2788
Practice Address - Street 1:54 MARANATHA BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-6818
Practice Address - Country:US
Practice Address - Phone:863-471-2766
Practice Address - Fax:863-471-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10086310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility