Healthcare Provider Details

I. General information

NPI: 1649268335
Provider Name (Legal Business Name): SMITHFIELD MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 BERKSHIRE RD
SMITHFIELD NC
27577-4731
US

IV. Provider business mailing address

PO BOX 1940
SMITHFIELD NC
27577-1940
US

V. Phone/Fax

Practice location:
  • Phone: 919-934-3171
  • Fax: 919-934-5960
Mailing address:
  • Phone: 919-934-3171
  • Fax: 919-934-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0182
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3415175
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier00939
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name: MR. DAVID F ARNN SR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 919-934-3171