MEDICARE: MANOR HOUSE COLLECTION, 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
1	225000000X	Orthotic Fitter

General Provider Information

NPI Number	:	1659576239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR HOUSE COLLECTION, INC.

Provider Business Mailing Address
First Line	:	1603 N MARKET DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6259
Country	:	US
Telephone Number	:	919-876-8677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1603 N MARKET DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6259
Country	:	US
Telephone Number	:	919-876-8677
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RUTH LEWIS DOWDY
Credential	:
Telephone Number	:	919-876-8677

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	09/05/2008

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Directions to “MANOR HOUSE COLLECTION, INC. ” Practice Location

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