Provider Demographics
NPI:1932197050
Name:AMELIA MANOR, INC
Entity Type:Organization
Organization Name:AMELIA MANOR, INC
Other - Org Name:AMELIA MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-234-7331
Mailing Address - Street 1:903 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3901
Mailing Address - Country:US
Mailing Address - Phone:337-234-7331
Mailing Address - Fax:337-235-9734
Practice Address - Street 1:903 CENTER ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3901
Practice Address - Country:US
Practice Address - Phone:337-234-7331
Practice Address - Fax:337-232-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA331313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA30512OtherBLUECROSS BLUESHIELD
LA1514055Medicaid
LA1514055Medicaid