Healthcare Provider Details

I. General information

NPI: 1366522005
Provider Name (Legal Business Name): THE MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 WASHINGTON HIGHWAY
MORRISVILLE VT
05661
US

IV. Provider business mailing address

577 WASHINGTON HIGHWAY
MORRISVILLE VT
05661
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-8700
  • Fax: 802-888-8782
Mailing address:
  • Phone: 802-888-8700
  • Fax: 802-888-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0378
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0270000273
License Number StateVT

VIII. Authorized Official

Name: MRS. LYNNETTE A SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 802-888-8752