Healthcare Provider Details

I. General information

NPI: 1174553861
Provider Name (Legal Business Name): MANOR OAKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3821
US

IV. Provider business mailing address

1601 NE 26TH ST
WILTON MANORS FL
33305-1410
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8400
  • Fax: 954-772-7149
Mailing address:
  • Phone: 954-566-8353
  • Fax: 954-563-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSNF1640096
License Number StateFL

VIII. Authorized Official

Name: MRS. SALLY P BOLEN
Title or Position: CFO
Credential:
Phone: 954-566-8353