Healthcare Provider Details

I. General information

NPI: 1124049044
Provider Name (Legal Business Name): MANOR ESTATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LOUISIANA BLVD NE
ALBUQUERQUE NM
87108-2051
US

IV. Provider business mailing address

105 N TRENTON ST
RUSTON LA
71270-4321
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1717
  • Fax: 505-255-5188
Mailing address:
  • Phone: 318-255-1514
  • Fax: 318-255-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5019
License Number StateNM

VIII. Authorized Official

Name: MR. DANNY N MILAM
Title or Position: GENERAL PARTNER
Credential:
Phone: 318-255-1514