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General NPI Number Information
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NPI Number | 1255584108
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Entity Type | Organization
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Legal Business Name | PIKE MANOR INC.
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 10642 HIGHWAY 19 N
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City | ZEBULON
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State | GA
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Zip | 30295-3192
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Country | US
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Telephone | 770-567-0200
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Fax | 770-567-0010
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Provider Business Mailing Address
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Address Line | 10642 HIGHWAY 19 N
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City | ZEBULON
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State | GA
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Zip | 30295-3192
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Country | US
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Telephone | 770-567-0200
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Fax | 770-567-0010
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Authorized Official
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Title or Position | CEO/CFO
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Name | CHRISTA COOK
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Credential | CEO/CFO; PT
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Telephone | 770-567-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 114030011
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License Number State | GA
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