SOUTH HAVEN MANOR, INC. (NPI# 1811024698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811024698 |
| Entity Type | Organization |
| Organization Name | SOUTH HAVEN MANOR, INC. |
| Practice Address |
114 Nursing Home Rd Hertford NC 27944-8879 |
| Practice Telephone | 4348480294 |
| Practice Fax Number | 4348488302 |
| Mailing Telephone | 4348480294 |
| Mailing Fax Number | 4348488302 |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. GRETCHEN GOLDMAN-OWENS (FISCAL AGENT) |
| Authorized Official Telephone | 4348480294 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
HAL-072-006 | NC | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 7804235 | 05 |
| Street Address |
114 NURSING HOME RD |
| City | HERTFORD |
| State | NC |
| Zip Code | 27944-8879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306479662 | Perquimans Opco Holdings LLC | Non-emergency Medical Transport (VAN) | 603 South Church St, Hertford, NC 27944 | 2020-02-14 |
| 1952825812 | Family Care Pharmacy, Inc | Pharmacy | 606 S. Church St., Hertford, NC 27944 | 2017-08-01 |
| 1568834976 | Erich Paul Junger | Counselor | 207 Hwy 343 South, Camden, NC 27944 | 2015-10-24 |
| 1053718858 | Douglas W. Perry | Dentist | 181 Perry Long Road, Hertford, NC 27944 | 2014-11-24 |
| 1396086971 | Hertford Healthcare, LLC | Assisted Living Facility | 464 Two Mile Desert Road, Hertford, NC 27944 | 2013-03-07 |
| 1063559920 | Perquimans County Schools | Local Education Agency (LEA) | 411 Edenton Road Street, Hertford, NC 27944 | 2007-01-31 |
| 1124173620 | Albemarle Mental Health Center | Clinical Neuropsychologist | 101arpdc Street, Hertford, NC 27944 | 2007-01-24 |
| 1710031521 | Albemarle Mental Health Center | Social Worker | 101 Arpdc Street, Hertford, NC 27944 | 2007-01-22 |
| 1245391770 | Stephanie Stallings Gregory | Pharmacist | 606 South Church St, Hertford, NC 27944 | 2006-12-12 |
| 1861565640 | Douglas W Perry Dds Pa | Dentist | 181 Perry Long Rd, Hertford, NC 27944 | 2006-11-17 |
| Find all providers in zip 27944 | ||||
| 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 |
|---|---|---|---|---|
| 1386044816 | Hertford Manor | Custodial Care Facility | 464 Two Mile Desert Rd, Hertford, NC 27944-8686 | 2014-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162061 | Lewis E Williams | Custodial Care Facility | 1640 Bridgedale Dr, Rocky Mount, NC 27803-1604 | 2020-10-26 |
| 1861008583 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 13937 Us Highway 17, Hampstead, NC 28443-4041 | 2020-09-17 |
| 1124645544 | Charlotte Sp Senior Housing Opco, LLC | Custodial Care Facility | 6041 Piedmont Row Drive, Charlotte, NC 28208 | 2020-07-01 |
| 1740804111 | Happy Hearts Group Home | Custodial Care Facility | 6255 Burlington Rd, Gibsonville, NC 27249-8783 | 2020-06-02 |
| 1730703422 | Graham 4 Enterprises | Custodial Care Facility | 3006 W Sedgefield Dr, Greensboro, NC 27407-7313 | 2020-05-29 |
| 1477177111 | C&s Adult Care LLC, Dba Deal Care Inn | Custodial Care Facility | 1075 Deal Rd, Mooresville, NC 28115-6719 | 2020-05-28 |
| 1114554516 | Cassandra Davis | Custodial Care Facility | 131 Huntington Rd, Louisburg, NC 27549 | 2020-03-25 |
| 1356975767 | Cornerstone Community Service | Custodial Care Facility | 2220 Southgate St, Durham, NC 27703-2102 | 2020-02-24 |
| 1477184653 | Rose Vista Assisted Living, LLC | Custodial Care Facility | 2130 Rose Vista Rd, Kinston, NC 28504-8230 | 2020-01-28 |
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
| Find all providers with the same taxonomy | ||||
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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.