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General NPI Number Information
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NPI Number | 1043363898
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Entity Type | Organization
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Legal Business Name | THE MANOR
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 115 EAST ST
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City | JONESVILLE
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State | MI
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Zip | 49250-1007
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Country | US
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Telephone | 517-849-2151
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Fax | 517-849-2880
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Provider Business Mailing Address
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Address Line | 115 EAST ST P.O. BOX 98
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City | JONESVILLE
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State | MI
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Zip | 49250-1007
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Country | US
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Telephone | 517-849-2151
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Fax | 517-849-2880
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | MR. FRED PRASSER
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Credential | ACSW
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Telephone | 517-849-2151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | C1300201277
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License Number State | MI
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