MEDICARE: INTEGRITY - DIXIE OAK MANOR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	AL8502	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144749037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY - DIXIE OAK MANOR, LLC

Provider Business Mailing Address
First Line	:	4900 KOGER BLVD STE 150
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2738
Country	:	US
Telephone Number	:	336-438-1376
Fax Number	:	336-438-1387

Provider Business Practice Location Address
First Line	:	6410 OLD DIXIE HWY
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-5909
Country	:	US
Telephone Number	:	772-569-7777
Fax Number	:

Authorized Official
Title or Position	:	CIO
Name	:	JONATHAN SWAIN SHORT
Credential	:
Telephone Number	:	336-438-1383

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	11/18/2021

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