South Haven Manor, Inc.

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

HAL-072-006 Issued in NC

Legal business name

SOUTH HAVEN MANOR, INC.

Practice address

114 Nursing Home Rd
Hertford, NC 27944-8879

Phone

(434) 848-0294

Fax

(434) 848-8302

NPI assigned

Feb 27, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Gretchen Goldman-Owens

Title

Fiscal Agent

Phone

(434) 848-0294

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811024698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 NURSING HOME RD",
            "city": "HERTFORD",
            "state": "NC",
            "postal_code": "279448879",
            "telephone_number": "434-848-0294",
            "fax_number": "434-848-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 NURSING HOME RD",
            "city": "HERTFORD",
            "state": "NC",
            "postal_code": "279448879",
            "telephone_number": "434-848-0294",
            "fax_number": "434-848-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAVEN MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN-OWENS",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "FISCAL AGENT",
        "authorized_official_telephone_number": "434-848-0294",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "HAL-072-006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804235",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Hertford, NC
• Providers in Hertford, 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 Aug 22, 2020; 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.