# THE MANOR HOUSE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306072194
- **Authorized official:** MRS. BETTY ANN REYNOLDS-MACIEJEWSKI (OWNER)
- **Authorized official phone:** 12319470463

## Contact information

- **Practice address:** 1258 LAKE DR, TRAVERSE CITY, MI 49684-8288
- **Practice address phone:** (123) 194-7046
- **Mailing address:** 1258 LAKE DR, TRAVERSE CITY, MI 49684-8288
- **Mailing address phone:** (123) 194-7046

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 385H00000X | Respite Care | AF280260935 | MI | Yes |

## Other

- **Enumeration date:** 06/07/2009
- **Last updated:** 06/07/2009