Provider Demographics
NPI:1063789501
Name:MONROE MANOR ASSISTED LIVING INC
Entity type:Organization
Organization Name:MONROE MANOR ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVEY
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-776-9327
Mailing Address - Street 1:1101 BAUCOM RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-7584
Mailing Address - Country:US
Mailing Address - Phone:704-776-9327
Mailing Address - Fax:866-609-8952
Practice Address - Street 1:1101 BAUCOM RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7584
Practice Address - Country:US
Practice Address - Phone:704-776-9327
Practice Address - Fax:866-609-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility