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GLENN KRYSTLE MANOR NPI 1700906070


NPI Information

NPI: 1700906070
Provider Name: GLENN KRYSTLE MANOR
Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
220 DAVIS ST
FAYETTEVILLE, NC
ZIP 28305
Phone: (910) 486-8854
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GLENN KRYSTLE MANOR is an adult care home custodial care facility in Fayetteville, NC. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. GLENN KRYSTLE MANOR NPI is 1700906070. The provider is registered as an organization entity type.

The provider's business location address is:

220 DAVIS ST
FAYETTEVILLE, NC
ZIP 28305-346
Phone: (910) 486-8854

The provider's authorized official is Cynthia Danetta Garrison .
The authorized official title is OWNER ADMINISTRATORAdministrator and has the following contact phone number (910) 527-4673.

The enumeration date for this NPI number is 3/30/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1311ZA0620XCustodial Care FacilityAdult Care HomeFCL-026-049NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17805650MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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