Healthcare Provider Details

I. General information

NPI: 1881730448
Provider Name (Legal Business Name): MANUEL'S SUPPORTIVE LIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 BAILEYS PARK LN
KINSTON NC
28504-7766
US

IV. Provider business mailing address

PO BOX 2580
KINSTON NC
28502-2580
US

V. Phone/Fax

Practice location:
  • Phone: 252-527-4052
  • Fax:
Mailing address:
  • Phone: 252-527-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA MANUEL
Title or Position: DIRECTOR
Credential:
Phone: 252-527-4052