MEDICARE: THE MANOR

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	310400000X	Assisted Living Facility	APPLIED	AR

General Provider Information

NPI Number	:	1689017212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MANOR

Provider Business Mailing Address
First Line	:	9800 MAUMELLE BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-7027
Country	:	US
Telephone Number	:	501-444-2390
Fax Number	:	501-421-9140

Provider Business Practice Location Address
First Line	:	9800 MAUMELLE BLVD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-7027
Country	:	US
Telephone Number	:	501-444-2390
Fax Number	:	501-421-9140

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SCOTT KINGSBOROUGH
Credential	:
Telephone Number	:	501-444-2390

Provider Enumeration Date	:	04/13/2013
Last Update Date	:	04/13/2013

Similar Medicare Providers

1730163072 — MAUMELLE PHYSICAL THERAPY
Practice Location Address:

9843 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-851-6600
Practice Fax: 501-851-6643

1114901451 — KENNY A DE LUCA P.T.
Practice Location Address:

9843 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-753-2201
Practice Fax: 501-753-2207

1194430561 — MARY ELIZABETH COX APRN,FNP-C
Practice Location Address:

9821 MAUMELLE BLVD
NORTH LITTLE ROCK, AR
72113-7027

Practice Phone: 501-779-3559
Practice Fax:

1285334300 — JOANNA PATRICE GREEN
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-410-1567
Practice Fax:

1306546429 — MELLISSA WOLF
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-410-1567
Practice Fax:

1942900063 — ELLEN DAWN SULLIVAN
Practice Location Address:

12320 INTERSTATE 30
LITTLE ROCK, AR
72210-7027

Practice Phone: 501-658-6010
Practice Fax:

Directions to “THE MANOR ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.