Healthcare Provider Details

I. General information

NPI: 1619007945
Provider Name (Legal Business Name): INGRAM HEALTH SERVICE MANNA HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S HICKORY ST
ROWLAND NC
28383-9602
US

IV. Provider business mailing address

675 NC HIGHWAY 71 N
MAXTON NC
28364-8741
US

V. Phone/Fax

Practice location:
  • Phone: 910-422-2273
  • Fax: 910-422-9889
Mailing address:
  • Phone: 910-422-2273
  • Fax: 910-422-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS DEBORAH FAYE INGRAM
Title or Position: CEO
Credential:
Phone: 910-422-2273