NPIMap

Organization Active NPI

White Oak Manor-Waxhaw Inc

Doing business as White Oak of Waxhaw

  • Skilled Nursing Facility
  • Waxhaw, NC
National Provider Identifier
1124342241
Registry record updated Jul 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0628 Issued in NC
Legal business name
WHITE OAK MANOR-WAXHAW INC
Doing business as
White Oak of Waxhaw
Practice address
700 Howie Mine Rd
Waxhaw, NC 28173-9715
Phone
(704) 243-7640
Fax
(704) 243-7641
NPI assigned
Mar 18, 2010
Last updated
Jul 1, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
WHITE OAK MANOR INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. David Joe Haney
Title
Vice President of Finance
Phone
(864) 327-1162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH0628 NC Primary

Addresses

Primary practice location

700 Howie Mine Rd
Waxhaw, NC 28173-9715

Mailing address

700 Howie Mine Rd
Waxhaw, NC 28173-9715
Phone (704) 243-7640

Other identifiers 2

IdentifierTypeStateIssuer
3405550MedicaidNC
34-5550OtherNCMEDICARE

Other names 1

  • White Oak of Waxhaw Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100325000592 NC Part A Provider - Skilled Nursing Facility 5991831372 Practice locations: Waxhaw, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124342241. Details of each certification follow.

Skilled nursing facility certification: CCN 345550

Legal name
WHITE OAK MANOR-WAXHAW INC
Doing business as
WHITE OAK OF WAXHAW
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 15, 2010
Last certification
Aug 2, 2024
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
National Healthcare Corp
Most recent change of ownership
Aug 1, 2024
Organization structure
CorporationProprietary
Incorporated
Sep 8, 2009 in NC
Enrollment address
700 Howie Mine Road
Waxhaw, NC 28173-9715

Care Compare: Nursing home

Medicare Care Compare
Listed as
White Oak of WaxhawCCN 345550 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Apr 15, 2010
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10090.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Part of
White Oak Manor Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

700 Howie Mine Rd
Waxhaw, NC 28173
Phone (704) 243-7640

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jeni C Feeser Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2022 21%
Corporate DirectorBoard Member Oct 1, 2002 5%
Lauren Cecil Greenwood Individual W-2 Managing EmployeeAdministrator Mar 31, 2014 25%
Dorothy D Cecil Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2022 21%
Corporate DirectorBoard Member Oct 1, 2002 5%
White Oak Management, Inc. Organization, Spartanburg, SC Management services company Operational/Managerial Control Jan 25, 2010 24%
White Oak Manor Inc Organization, Spartanburg, SC Corporation 5% Or Greater Direct Ownership Interest Jan 25, 2010 100%
Oliver K Cecil Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2022 18%
Corporate OfficerCeo Oct 1, 2002 5%
Corporate DirectorBoard Member Oct 1, 2002 5%
Beth C Cecil Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2022 21%
Corporate DirectorBoard Member Oct 1, 2002 5%
Douglas M Cecil Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2022 19%
Corporate OfficerPresident Oct 1, 2002 5%
Corporate DirectorBoard Member Oct 1, 2002 5%
David J Haney Individual Corporate OfficerVP of Finance Oct 1, 2002 1%
John P Barber Individual Corporate OfficerCfo Oct 1, 2002 5%
Corporate DirectorBoard Member Jan 25, 2009 5%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277942400000",
    "number": "1124342241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HOWIE MINE RD",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281739715",
            "telephone_number": "704-243-7640",
            "fax_number": "704-243-7641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HOWIE MINE RD",
            "city": "WAXHAW",
            "state": "NC",
            "postal_code": "281739715",
            "telephone_number": "704-243-7640",
            "fax_number": "704-243-7641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE OAK MANOR-WAXHAW INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE OAK MANOR INC",
        "enumeration_date": "2010-03-18",
        "last_updated": "2010-07-01",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "864-327-1162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NC",
            "license": "NH0628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3405550",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "34-5550",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Oak of Waxhaw",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waxhaw, NC

Sources for this page

Verify at the official NPI Registry.