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General NPI Number Information
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NPI Number | 1083838585
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Entity Type | Organization
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Legal Business Name | LAND MANOR, INC.
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 355 N 18TH ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77707-2229
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Country | US
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Telephone | 409-838-3946
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Fax | 409-838-4298
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Provider Business Mailing Address
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Address Line | PO BOX 7250
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City | BEAUMONT
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State | TX
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Zip | 77726-7250
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Country | US
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Telephone | 409-838-3946
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Fax | 409-838-4298
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Authorized Official
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Title or Position | QUALITY MANAGEMENT DIRECTOR
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Name | MS. CHERYL ANN KAHCLAMAT
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Credential | LCDC
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Telephone | 409-838-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 124-F
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 124-124H
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License Number State | TX
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