MEDICARE: MANOR OAKS, INC.

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	314000000X	Skilled Nursing Facility	SNF1640096	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	:	1174553861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR OAKS, INC.

Provider Business Mailing Address
First Line	:	1601 NE 26TH ST
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33305-1410
Country	:	US
Telephone Number	:	954-566-8353
Fax Number	:	954-563-3939

Provider Business Practice Location Address
First Line	:	2121 E COMMERCIAL BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3821
Country	:	US
Telephone Number	:	954-771-8400
Fax Number	:	954-772-7149

Authorized Official
Title or Position	:	CFO
Name	:	MRS. SALLY P BOLEN
Credential	:
Telephone Number	:	954-566-8353

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	02/17/2012

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Directions to “MANOR OAKS, INC. ” Practice Location

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