Annadale Manor, Inc

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

ANNADALE MANOR, INC

Doing business as

23rd Manor

Practice address

5423 23Rd St
Lubbock, TX 79407-2124

Phone

(806) 441-7798

NPI assigned

Jun 23, 2015

Organization subpart

Yes

Parent organization

ANNADALE MANOR, INCAs reported in NPPES

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

Authorized official

Name

Toni Jennings

Title

Administrator

Phone

(806) 441-7798

Specialties & licenses 1

Addresses

Other names 1

• 23rd Manor Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45G854

Legal name

23RD MANOR

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Nov 7, 1991

Last certification

Feb 5, 2025

Beds

6

Ownership / control type

Private (proprietary)

Facility address

5423 23Rd St
Lubbock, TX 79407

Tax ID family

Annadale Manor Inc2 organizations share this tax ID, including this one

Part of

Annadale Manor Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Annadale Manor, Inc

  dba 23rd Manor

  • Intellectual Disabilities Intermediate Care Facility
  • Wolfforth, TX
  • NPI 1790834323
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Annadale Manor, Inc

  dba 23rd Manor

  • Intellectual Disabilities Intermediate Care Facility
  • Wolfforth, TX
  • NPI 1790834323
  NPPES parent name

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

{
    "created_epoch": "1435017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725840000000",
    "number": "1508248998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65725",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794645681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5423 23RD ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794072124",
            "telephone_number": "806-441-7798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNADALE MANOR, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNADALE MANOR, INC",
        "enumeration_date": "2015-06-23",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A",
        "authorized_official_last_name": "JENNINGS",
        "authorized_official_first_name": "TONI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "806-441-7798"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "23rd Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angelo Kidney Connection Home Therapies PLLC
• Angels for Hire LLP (Visiting Angels of Lubbock)
• Elizabeth Angerer, LVN
• Hitiura Anihia, PH.D, LMFT-ASSOCIATE
• Tabitha Ankers, MD
• Kylie Elizabeth Annen, PHARM.D.
• Robert Ans, RBT
• Mohammad Mehdi Ansari, M.D.
• James Adam Antal
• Kori Anthony, PT

• Intellectual Disabilities Intermediate Care Facility in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.