Basic Information
| Provider Information | |||||||||
| NPI: | 1649501453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHELBY MANOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1176 WYKE RD | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281504273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044820000 | ||||||||
| FaxNumber: | 7044870772 | ||||||||
| Practice Location | |||||||||
| Address1: | 1176 WYKE RD | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281504273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044820000 | ||||||||
| FaxNumber: | 7044870772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2010 | ||||||||
| LastUpdateDate: | 01/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | DORMAN | ||||||||
| AuthorizedOfficialFirstName: | BOBBI | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7044820000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.