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NPI Code Detail

MEDICARE: WHITE OAK MANOR INC

MEDICARE: WHITE OAK MANOR INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityNCF-886SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15288330001OTHERSCNSC MEDICARE ID-PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659406668
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE OAK MANOR INC
Provider Business Mailing Address
First Line : PO BOX 3347
Second Line :
City : SPARTANBURG
State : SC
Zip : 29304-3347
Country : US
Telephone Number : 803-782-4363
Fax Number : 803-782-4366
Provider Business Practice Location Address
First Line : 3001 BEECHAVEN RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29204-2701
Country : US
Telephone Number : 803-782-4363
Fax Number : 803-782-4366
Authorized Official
Title or Position : VP FINANCE
Name : MR. DAVID JOE HANEY
Credential :
Telephone Number : 864-327-1162
Provider Enumeration Date : 02/22/2007
Last Update Date : 11/05/2008

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Directions to “WHITE OAK MANOR INC ” Practice Location

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