Elcm Manor South Management LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

ELCM MANOR SOUTH MANAGEMENT LLC

Doing business as

Pillsbury Manor South

Practice address

20 Harbor View Rd
South Burlington, VT 05403-7850

Phone

(802) 863-7897

Fax

(802) 863-9728

NPI assigned

Sep 15, 2016

Last updated

Sep 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Paul Boethel

Title

Principal

Phone

(972) 728-8739

Specialties & licenses 1

Addresses

Other names 1

• Pillsbury Manor South Doing business as

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

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473897600000",
    "number": "1447708771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14241 DALLAS PKWY STE 650",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752542953",
            "telephone_number": "214-417-4588",
            "fax_number": "214-594-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HARBOR VIEW RD",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037850",
            "telephone_number": "802-863-7897",
            "fax_number": "802-863-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELCM MANOR SOUTH MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-15",
        "last_updated": "2016-09-15",
        "status": "A",
        "authorized_official_last_name": "BOETHEL",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "972-728-8739",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "VT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pillsbury Manor South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Care Home Facility in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Adult Care Home Facility in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.