# SHELBY MANOR GROUP HOME

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

## Provider details

- **NPI number:** 1740339126
- **Authorized official:** MR. DENNIS R. OWENS (EXECUTIVE VICE PRESIDENT)
- **Authorized official phone:** (276) 628-5000

## Contact information

- **Practice address:** 1176 WYKE RD, SHELBY, NC 28150-4273
- **Practice address phone:** (276) 628-5000
- **Practice address fax:** (276) 623-2148
- **Mailing address:** 100 ABINGDON PL, ABINGDON, VA 24211-6122
- **Mailing address phone:** (276) 628-5000
- **Mailing address fax:** (276) 623-2148

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | HAL023008 | NC | Yes |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7803639 | — | NC |