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General NPI Number Information
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NPI Number | 1437609948
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Entity Type | Organization
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Legal Business Name | MERCY MANOR AT SAYBROOKE, INC
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Dates
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Enumeration Date | 10/07/2016
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 6320 SAYBROOKE DRIVE
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City | RALEIGH
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State | NC
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Zip | 27604
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Country | US
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Telephone | 919-878-1912
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Fax | 919-790-9970
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Provider Business Mailing Address
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Address Line | 2804 TREVI FOUNTAIN PLACE
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City | WAKE FOREST
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State | NC
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Zip | 27587
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Country | US
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Telephone | 919-878-1912
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Fax | 919-790-9970
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. EBERE CHINAKA COLLINS
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Credential | RN, BSN
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Telephone | 919-271-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | FCL-092-221
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License Number State | NC
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