Provider Demographics
NPI:1730214768
Name:WHITE OAK MANOR INC
Entity type:Organization
Organization Name:WHITE OAK MANOR INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-327-1162
Mailing Address - Street 1:PO BOX 3347
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-3347
Mailing Address - Country:US
Mailing Address - Phone:864-579-7004
Mailing Address - Fax:864-579-7714
Practice Address - Street 1:400 WEBBER RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-2400
Practice Address - Country:US
Practice Address - Phone:864-579-7004
Practice Address - Fax:864-579-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCNCF-888314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5246670001OtherNSC MEDICARE ID-PTAN
SC0466NHMedicaid
SC0255500012Medicare NSC
SC0466NHMedicaid