Organization · NPI-2

Annadale Manor, INC

Intermediate Care Facility, Intellectual Disabilities · Lubbock, TX

NPI number1508248998
StatusActive
Last updated in NPPESSep 9, 2024

Details

NPI
1508248998
Entity type
Organization (NPI-2)
Legal business name
Annadale Manor, INC
Organization subpart
Yes
Enumeration date
Jun 23, 2015
Certification date
Sep 9, 2024
Last updated
Sep 9, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
315P00000X Intermediate Care Facility, Intellectual Disabilities––Yes

Other names

  • 23rd Manor (Doing Business As)

Practice location

5423 23rd St
Lubbock, TX 79407-2124

Phone 806-441-7798

Mailing address

Po Box 65725
Lubbock, TX 79464-5681

Authorized official

Toni Jennings
Administrator
8064417798

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