Organization
WHITE OAK MANOR-WAXHAW INC
Active
Parent organization
WHITE OAK MANOR INC
Other names
White Oak of Waxhaw
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHITE OAK MANOR INC
Authorized official
MR. DAVID JOE HANEY (VICE PRESIDENT OF FINANCE)
(864) 327-1162
Entity
Organization
Contact information
Practice address
700 HOWIE MINE RD, WAXHAW, NC 28173-9715
(704) 243-7640
(704) 243-7641
Mailing address
700 HOWIE MINE RD, WAXHAW, NC 28173-9715
(704) 243-7640
(704) 243-7641
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0628
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34-5550
MEDICARE
NC
05
—
3405550
—
NC
Enumeration date
03/18/2010
Last updated
07/01/2010
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