Provider Demographics
NPI:1699163089
Name:THE MANOR AT WHITEHALL
Entity type:Organization
Organization Name:THE MANOR AT WHITEHALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY REHAB DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWL
Authorized Official - Suffix:
Authorized Official - Credentials:ST
Authorized Official - Phone:256-348-7536
Mailing Address - Street 1:4805 LANGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6125
Mailing Address - Country:US
Mailing Address - Phone:614-501-8271
Mailing Address - Fax:
Practice Address - Street 1:4805 LANGLEY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6125
Practice Address - Country:US
Practice Address - Phone:614-501-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4411314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility