Healthcare Provider Details

I. General information

NPI: 1639002959
Provider Name (Legal Business Name): SURRY MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LINCOLN LN
SURRY ME
04684-3510
US

IV. Provider business mailing address

7 LINCOLN LN
SURRY ME
04684-3510
US

V. Phone/Fax

Practice location:
  • Phone: 501-414-4841
  • Fax:
Mailing address:
  • Phone: 501-414-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DENISE WHITE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 501-414-4841