Glenn Krystle Manor

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL-026-049 Issued in NC

Legal business name

GLENN KRYSTLE MANOR

Practice address

220 Davis St
Fayetteville, NC 28305-5346

Phone

(910) 486-8854

NPI assigned

Mar 30, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Cynthia Danetta Garrison

Title

Administrator/Owner

Phone

(910) 527-4673

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1700906070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1887 SPIRALWOOD DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283040499",
            "telephone_number": "910-527-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 DAVIS ST",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055346",
            "telephone_number": "910-486-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN KRYSTLE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "DANETTA",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "910-527-4673",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL-026-049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805650",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Stuart Glaser, MD
• Susan Rena Glass, NP
• Guy G Glatz, M.D.
• Debra K Gleason, PH.D.
• Tyler Ariell Glee, LCSWA, MSW
• Glitzy LLC
• Global Outreach Telerehabilitation
• GM&SB Investments LLC
• Goal Digger Network LLC
• William Nelson Goble, PH.D.

• Adult Care Home Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; 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.