Organization
WHITE OAK MANOR INC
Active
Other names
White Oak Manor Columbia
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JOE HANEY (VP FINANCE)
(864) 327-1162
Entity
Organization
Contact information
Practice address
3001 BEECHAVEN RD, COLUMBIA, SC 29204-2701
(803) 782-4363
(803) 782-4366
Mailing address
PO BOX 3347, SPARTANBURG, SC 29304-3347
(803) 782-4363
(803) 782-4366
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NCF-886
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0461NH
—
SC
01
—
5288330001
NSC MEDICARE ID-PTAN
SC
Enumeration date
02/22/2007
Last updated
11/05/2008
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