Organization
INGRAM HEALTH SERVICES/MANNA HOUSE,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS DEBORAH FAYE INGRAM (CEO)
(910) 318-3946
Entity
Organization
Contact information
Practice address
505 WEST MARTIN LUTHER KING DRIVE, MAXTON, NC 28364
(910) 844-6262
(910) 844-6265
Mailing address
675 NC HWY 71 N, MAXTON, NC 28364
(910) 844-6262
(910) 844-6265
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301873
—
NC
Enumeration date
07/14/2009
Last updated
07/14/2009
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