Healthcare Provider Details

I. General information

NPI: 1689709693
Provider Name (Legal Business Name): WHITE OAK MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 KINARD ST
NEWBERRY SC
29108-2954
US

IV. Provider business mailing address

PO BOX 3347
SPARTANBURG SC
29304-3347
US

V. Phone/Fax

Practice location:
  • Phone: 803-276-6060
  • Fax: 803-321-9244
Mailing address:
  • Phone: 803-276-6060
  • Fax: 803-321-9244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNCF-884
License Number StateSC

VIII. Authorized Official

Name: MR. DAVID JOE HANEY
Title or Position: VP FINANCE
Credential:
Phone: 864-327-1162