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General NPI Number Information
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NPI Number | 1790782639
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Entity Type | Organization
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Legal Business Name | NORTH SHORE MANOR, INC.
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 1365 W 29TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-2561
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Country | US
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Telephone | 970-677-6111
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Fax | 970-667-2460
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Provider Business Mailing Address
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Address Line | 1365 W 29TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-2561
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Country | US
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Telephone | 970-677-6111
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Fax | 970-667-2460
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Authorized Official
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Title or Position | A/R MANAGER
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Name | MRS. DEB PRENTISS
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Credential |
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Telephone | 970-482-0198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0214
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License Number State | CO
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