Organization
SHELBY MANOR GROUP HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS R. OWENS (EXECUTIVE VICE PRESIDENT)
(276) 628-5000
Entity
Organization
Contact information
Practice address
1176 WYKE RD, SHELBY, NC 28150-4273
(276) 628-5000
(276) 623-2148
Mailing address
100 ABINGDON PL, ABINGDON, VA 24211-6122
(276) 628-5000
(276) 623-2148
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL023008
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803639
—
NC
Enumeration date
01/09/2007
Last updated
08/22/2020
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