Organization
SOUTH HAVEN MANOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GRETCHEN GOLDMAN-OWENS (FISCAL AGENT)
(434) 848-0294
Entity
Organization
Contact information
Practice address
114 NURSING HOME RD, HERTFORD, NC 27944-8879
(434) 848-0294
(434) 848-8302
Mailing address
114 NURSING HOME RD, HERTFORD, NC 27944-8879
(434) 848-0294
(434) 848-8302
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
HAL-072-006
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804235
—
NC
Enumeration date
02/27/2007
Last updated
08/22/2020
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