Provider Demographics
NPI:1124049044
Name:MANOR ESTATES INC
Entity type:Organization
Organization Name:MANOR ESTATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-255-1514
Mailing Address - Street 1:105 N TRENTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4321
Mailing Address - Country:US
Mailing Address - Phone:318-255-1514
Mailing Address - Fax:318-255-1517
Practice Address - Street 1:500 LOUISIANA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2051
Practice Address - Country:US
Practice Address - Phone:505-255-1717
Practice Address - Fax:505-255-5188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI0001Medicaid
NM0457840001Medicare NSC
NM325045Medicare ID - Type UnspecifiedFEDERAL PROVIDER NUMBER