SOUTH HAVEN MANOR INC. NPI 1811024698

NPI Information

NPI: 1811024698
Provider Name: SOUTH HAVEN MANOR, INC.
Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

Address:
114 NURSING HOME RD
HERTFORD, NC
ZIP 27944
Phone: (434) 848-0294
Get Directions

SOUTH HAVEN MANOR, INC. is an adult care home custodial care facility in Hertford, 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. SOUTH HAVEN MANOR, INC. NPI is 1811024698. The provider is registered as an organization entity type.

The provider's business location address is:

114 NURSING HOME RD
HERTFORD, NC
ZIP 27944-879
Phone: (434) 848-0294
Fax: (434) 848-8302

The provider's authorized official is Gretchen Goldman-owens .
The authorized official title is Fiscal Agent and has the following contact phone number (434) 848-0294.

The enumeration date for this NPI number is 2/27/2007 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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	311ZA0620X	Custodial Care Facility	Adult Care Home	HAL-072-006	NORTH CAROLINA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7804235	MEDICAID	NORTH 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: 11/14/2023

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