Organization
WHITE OAK MANOR-CHARLOTTE
Active
Parent organization
WHITE OAK MANOR INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WHITE OAK MANOR INC
Authorized official
MR. DAVID J HANEY (VP OF FINANCE)
(864) 327-1162
Entity
Organization
Contact information
Practice address
130 E MAIN ST, SPARTANBURG, SC 29306-5113
(864) 327-1162
(864) 573-9107
Mailing address
4009 CRAIG AVE, CHARLOTTE, NC 28211-2505
(704) 365-2620
(704) 365-2624
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH0350
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3409244
MEDICAID-CAP
NC
Enumeration date
08/11/2010
Last updated
08/11/2010
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