Provider Demographics
NPI:1548244346
Name:ROCKINGHAM MANOR, LLC
Entity type:Organization
Organization Name:ROCKINGHAM MANOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-266-2911
Mailing Address - Street 1:804 S LONG DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4318
Mailing Address - Country:US
Mailing Address - Phone:910-997-4493
Mailing Address - Fax:910-997-4083
Practice Address - Street 1:804 S LONG DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4318
Practice Address - Country:US
Practice Address - Phone:910-997-4493
Practice Address - Fax:910-997-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH0427314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3446398Medicaid
NC3435378Medicaid
NC3446398Medicaid
NC3435378Medicaid