Provider Demographics
NPI:1649572710
Name:INGRAM HEALTH SERVICE/MANNA HOUSE.INC
Entity type:Organization
Organization Name:INGRAM HEALTH SERVICE/MANNA HOUSE.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-844-6262
Mailing Address - Street 1:211 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-3128
Mailing Address - Country:US
Mailing Address - Phone:910-844-6262
Mailing Address - Fax:910-844-6264
Practice Address - Street 1:211 N MARKET STREET
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:910-844-6262
Practice Address - Fax:910-844-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management