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General NPI Number Information
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NPI Number | 1780825034
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Entity Type | Organization
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Legal Business Name | NEWARK MANOR NURSING HOME
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 254 W MAIN ST
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City | NEWARK
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State | DE
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Zip | 19711-3235
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Country | US
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Telephone | 302-731-5576
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Fax | 302-731-8670
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Provider Business Mailing Address
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Address Line | 254 W MAIN ST
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City | NEWARK
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State | DE
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Zip | 19711-3235
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Country | US
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Telephone | 302-731-5576
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Fax | 302-731-8670
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MRS. DAVID BOYER
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Credential | NHA
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Telephone | 302-731-5576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1104
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License Number State | DE
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