GLENN KRYSTLE MANOR (NPI# 1700906070) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700906070 |
| Entity Type | Organization |
| Organization Name | GLENN KRYSTLE MANOR |
| Practice Address |
220 Davis St Fayetteville NC 28305-5346 |
| Mailing Address |
1887 Spiralwood Dr Fayetteville NC 28304-0499 |
| Practice Telephone | 9104868854 |
| Mailing Telephone | 9105274673 |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. CYNTHIA DANETTA GARRISON (OWNER ADMINISTRATOR) |
| Authorized Official Telephone | 9105274673 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
FCL-026-049 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7805650 | 05 |
| Street Address |
220 DAVIS ST |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28305-5346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083801534 | Brandin Manor Fch | Residential Treatment Facility, Physical Disabilities | 220 Davis St, Fayetteville, NC 28305-5386 | 2007-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437637733 | Shannon S Wiggins | Social Worker | 2525 Raeford Rd Ste A, Fayetteville, NC 28305 | 2018-07-30 |
| 1205345790 | Sarah Elizabeth Hudson | Marriage & Family Therapist | 214 Fairway Dr, Fayetteville, NC 28305 | 2017-09-27 |
| 1336533116 | Avalon Counseling Services Pa | Counselor | 916 B Arsenal Ave, Fayetteville, NC 28305 | 2015-03-19 |
| 1568882827 | Kenneth Brown | Counselor | 901 Arsenal Avenue, Suite, Fayetteville, NC 28305 | 2014-04-24 |
| 1174879423 | Lynette Maxwell Pierce | Dentist | 2537-b Raeford Rd, Fayetteville, NC 28305 | 2012-07-24 |
| 1356640973 | Charlene Jones | Social Worker | 560 Lambert St, Fayetteville, NC 28305 | 2011-03-22 |
| 1659518173 | Christine R Campbell | Speech-Language Pathologist | 2401 Roberson Street, Fayettville, NC 28305 | 2009-01-21 |
| 1588814628 | Zakiya S Karim | Pediatrics | 1327 Robeson Street, Fayetteville, NC 28305 | 2008-09-25 |
| 1710134770 | Bright Heart Healthcare Staffing | Nursing Care | 2504 Rareford Rd, Fayetteville, NC 28305 | 2008-08-21 |
| 1730272402 | Dale A Childers | Dentist | 2409 Robeson Street, Fayetteville, NC 28305 | 2006-10-02 |
| Find all providers in zip 28305 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790299717 | Just One Touch Homes | Custodial Care Facility | 2320 Rustic Trl, Fayetteville, NC 28306-3238 | 2017-11-29 |
| 1982063327 | Subtle Living, LLC | Custodial Care Facility | 183 Bonney Ln, Fayetteville, NC 28306-3735 | 2016-02-13 |
| 1164824322 | Sure Care | Custodial Care Facility | 110 Sylvan Loop, Fayetteville, GA 30214-7439 | 2014-09-18 |
| 1376978155 | Exton LLC | Custodial Care Facility | 220 Price Rd, Fayetteville, GA 30215-2019 | 2013-09-11 |
| 1598070708 | Puretouch Wellness Haven,inc | Custodial Care Facility | 110 Chandler Way, Fayetteville, GA 30215-2122 | 2010-08-11 |
| 1679693600 | Mcleod Family Care Center of Fayetteville | Custodial Care Facility | 248 Livermore Dr, Fayetteville, NC 28314-8616 | 2007-03-31 |
| 1124153382 | Mclean Family Care Home | Custodial Care Facility | 6487 Pleasant Rd, Fayetteville, NC 28314-0552 | 2007-02-21 |
| 1477604288 | Mcduffie Personal Care Services Inc | Custodial Care Facility | 1826 Wendover Dr, Fayetteville, NC 28304-1426 | 2007-01-16 |
| 1699847541 | Sophia B Pierce & Associates Inc | Custodial Care Facility | 611 Country Club Drive, Fayetteville, NC 28301 | 2006-11-15 |
| 1316584782 | Ga Hc Reit II Fayetteville Alf Trs Sub, LLC | Custodial Care Facility | 1164 71st School Rd, Fayetteville, NC 28314-2817 | 2019-12-04 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28305 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.