Healthcare Provider Details

I. General information

NPI: 1548244346
Provider Name (Legal Business Name): ROCKINGHAM MANOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 S LONG DR
ROCKINGHAM NC
28379-4318
US

IV. Provider business mailing address

804 S LONG DR
ROCKINGHAM NC
28379-4318
US

V. Phone/Fax

Practice location:
  • Phone: 910-997-4493
  • Fax: 910-997-4083
Mailing address:
  • Phone: 910-997-4493
  • Fax: 910-997-4083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0427
License Number StateNC

VIII. Authorized Official

Name: MRS. PAM BISHOP
Title or Position: TREASURER
Credential:
Phone: 864-266-2911