Provider Demographics
NPI:1861794356
Name:MANOR HOUSE
Entity type:Organization
Organization Name:MANOR HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-258-1312
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:ANTWERP
Mailing Address - State:OH
Mailing Address - Zip Code:45813-0759
Mailing Address - Country:US
Mailing Address - Phone:419-258-1500
Mailing Address - Fax:419-258-1509
Practice Address - Street 1:204 ARCHER DR
Practice Address - Street 2:
Practice Address - City:ANTWERP
Practice Address - State:OH
Practice Address - Zip Code:45813
Practice Address - Country:US
Practice Address - Phone:419-258-1500
Practice Address - Fax:419-258-1509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2449R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH164327447Medicaid