Healthcare Provider Details

I. General information

NPI: 1588743546
Provider Name (Legal Business Name): THE MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EAST ST
JONESVILLE MI
49250-1007
US

IV. Provider business mailing address

115 EAST ST P.O. BOX 98
JONESVILLE MI
49250-1007
US

V. Phone/Fax

Practice location:
  • Phone: 517-849-2151
  • Fax: 517-849-2880
Mailing address:
  • Phone: 517-849-2151
  • Fax: 517-849-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number4301075087
License Number StateMI

VIII. Authorized Official

Name: MR. FRED PRASSER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 517-849-2151