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General NPI Number Information
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NPI Number | 1962480186
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Entity Type | Organization
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Legal Business Name | MARANATHA MANOR OF SPARTANBURG, INC
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2902 E MAIN STREET EXT
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City | SPARTANBURG
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State | SC
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Zip | 29307-1252
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Country | US
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Telephone | 864-579-0086
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Fax | 864-579-0466
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Provider Business Mailing Address
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Address Line | 2902 E MAIN STREET EXT
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City | SPARTANBURG
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State | SC
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Zip | 29307-1252
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Country | US
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Telephone | 864-579-0086
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Fax | 864-579-0466
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SANDRA M WEST
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Credential |
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Telephone | 864-579-0086
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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 | CRC1235
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License Number State | SC
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