Organization
GLENN KRYSTLE MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA DANETTA GARRISON (OWNER ADMINISTRATOR)
(910) 527-4673
Entity
Organization
Contact information
Practice address
220 DAVIS ST, FAYETTEVILLE, NC 28305-5346
(910) 486-8854
Mailing address
1887 SPIRALWOOD DR, FAYETTEVILLE, NC 28304-0499
(910) 527-4673
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL-026-049
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805650
—
NC
Enumeration date
03/30/2007
Last updated
08/22/2020
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