Healthcare Provider Details

I. General information

NPI: 1366890865
Provider Name (Legal Business Name): CHAR-MAC OF MANNING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 11TH ST
MANNING IA
51455-1508
US

IV. Provider business mailing address

200 E CHAR MAC DR
LAWTON IA
51030-8171
US

V. Phone/Fax

Practice location:
  • Phone: 712-655-4893
  • Fax:
Mailing address:
  • Phone: 712-944-4893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberS0356
License Number StateIA

VIII. Authorized Official

Name: JEANINE K CHARTIER
Title or Position: OWNER
Credential: OTR/L
Phone: 712-944-4893