Provider Demographics
NPI:1700470069
Name:MANCHESTER HOUSE LLC
Entity Type:Organization
Organization Name:MANCHESTER HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:SECRETA
Authorized Official - Last Name:MUNDLE SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-548-1323
Mailing Address - Street 1:6108 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1474
Mailing Address - Country:US
Mailing Address - Phone:301-548-0100
Mailing Address - Fax:301-548-1323
Practice Address - Street 1:6108 GRANBY RD
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1474
Practice Address - Country:US
Practice Address - Phone:301-548-0100
Practice Address - Fax:301-548-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility