NPIMap

Organization Active NPI

White Oak Manor Charlotte Inc

  • Skilled Nursing Facility
  • Charlotte, NC
National Provider Identifier
1366577355
Registry record updated Nov 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NH0350 Issued in NC
Legal business name
WHITE OAK MANOR CHARLOTTE INC
Practice address
4009 Craig Ave
Charlotte, NC 28211-2505
Phone
(704) 365-2620
Fax
(704) 365-2624
NPI assigned
Feb 22, 2007
Organization subpart
Yes
Parent organization
WHITE OAK MANOR INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2007

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

Authorized official

Name
Mr. David Joe Haney
Title
VP Finance
Phone
(864) 327-1162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NH0350 NC Primary

Addresses

Primary practice location

4009 Craig Ave
Charlotte, NC 28211-2505

Mailing address

4009 Craig Ave
Charlotte, NC 28211-2505
Phone (704) 365-2620

Other identifiers 2

IdentifierTypeStateIssuer
3415238MedicaidNC
3416283MedicaidNC

Other names 1

  • White Oak Manor Charlotte Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507000768 NC Part A Provider - Skilled Nursing Facility 3274522099 Practice locations: Charlotte, NC

Skilled nursing facility certification: CCN 345238

Legal name
WHITE OAK MANOR CHARLOTTE INC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 15, 1983
Last certification
Mar 27, 2025
Beds
180
Ownership / control type
Corporation
Multi-facility organization
NHC
Organization structure
CorporationProprietary
Incorporated
Oct 1, 2002 in NC
Enrollment address
4009 Craig Ave
Charlotte, NC 28211-2561

Care Compare: Nursing home

Medicare Care Compare
Listed as
White Oak Manor - CharlotteCCN 345238
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 15, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
180141.2 residents per day on average
Penalties (3 years)
3Fines totaling $69,804

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.

Member organizations 8

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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%
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 Oct 1, 2002 24%
Dawn P Owens-Watterson Individual Contracted Managing EmployeeMedical Director Feb 28, 2024 5%
White Oak Manor Inc Organization, Spartanburg, SC Corporation 5% Or Greater Direct Ownership Interest Oct 1, 2002 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%
Hayden Keziah Individual W-2 Managing EmployeeAdministrator Feb 5, 2024 25%
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 Oct 1, 2002 5%

Owners & managing parties with NPI records 7

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": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195430400000",
    "number": "1366577355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 CRAIG AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112505",
            "telephone_number": "704-365-2620",
            "fax_number": "704-365-2624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 CRAIG AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282112505",
            "telephone_number": "704-365-2620",
            "fax_number": "704-365-2624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE OAK MANOR CHARLOTTE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE OAK MANOR INC",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-11-19",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JOE",
        "authorized_official_title_or_position": "VP 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": "NH0350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415238",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3416283",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Oak Manor Charlotte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.