Provider Demographics
NPI:1174553861
Name:MANOR OAKS, INC.
Entity type:Organization
Organization Name:MANOR OAKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-566-8353
Mailing Address - Street 1:1601 NE 26TH ST
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1410
Mailing Address - Country:US
Mailing Address - Phone:954-566-8353
Mailing Address - Fax:954-563-3939
Practice Address - Street 1:2121 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3821
Practice Address - Country:US
Practice Address - Phone:954-771-8400
Practice Address - Fax:954-772-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1640096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0256935-00Medicaid
FL0256935-00Medicaid