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

10702 County Road 1300
Wolfforth, TX 79382-7006

Phone

(806) 866-9186

NPI assigned

Jan 10, 2007

Last updated

Sep 2, 2025By 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

Mrs. 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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790834323. Details of each certification follow.

• CCN 45H031 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45H031

Legal name

ANNADALE MANOR INC.

Certification status

Active

Provider type (POS)

Intermediate care facility for individuals with intellectual disabilities

Participating since

Dec 17, 1992

Last certification

Jan 23, 2026

Beds

6

Ownership / control type

Private (proprietary)

Facility address

10702 County Rd 1300
Wolfforth, TX 79382

Tax ID family

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

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
  • Lubbock, TX
  • NPI 1508248998
  NPD tax ID

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Annadale Manor, Inc

  dba 23rd Manor

  • Intellectual Disabilities Intermediate Care Facility
  • Lubbock, TX
  • NPI 1508248998
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Craig Barker, MD

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1720059611
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1790834323",
    "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",
            "telephone_number": "806-441-7798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10702 COUNTY ROAD 1300",
            "city": "WOLFFORTH",
            "state": "TX",
            "postal_code": "793827006",
            "telephone_number": "806-866-9186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5423 23rd St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794072124",
            "country_code": "US",
            "telephone_number": "806-441-7798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANNADALE MANOR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2025-09-02",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "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"
        }
    ]
}

• 12TH Street Anesthesia PLLC
• Maria G Barraza, CNA
• Niska Aaron Blevins, DO
• Kayla Boyd, CCC-SLP
• Maggie Brendle
• Micah Chapman, OTR, MOT

• Intellectual Disabilities Intermediate Care Facility in Wolfforth, TX
• Providers in Wolfforth, 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 2, 2025; 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.