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General NPI Number Information
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NPI Number | 1790834323
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Entity Type | Organization
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Legal Business Name | ANNADALE MANOR, INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 10702 COUNTY ROAD 1300
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City | WOLFFORTH
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State | TX
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Zip | 79382-7006
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Country | US
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Telephone | 806-866-9186
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 65725
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City | LUBBOCK
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State | TX
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Zip | 79464-5681
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Country | US
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Telephone | 806-441-7798
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TONI JENNINGS
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Credential |
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Telephone | 806-441-7798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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