Basic Information
| Provider Information | |||||||||
| NPI: | 1699163089 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MANOR AT WHITEHALL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4805 LANGLEY AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432136125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145018271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4805 LANGLEY AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432136125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145018271 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2015 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CRAWL | ||||||||
| AuthorizedOfficialFirstName: | TRINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FACILITY REHAB DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2563487536 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SHG | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | ST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 4411 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.