| Organization Name: | MARYS MANOR |
| NPI Number: | 1326162363 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY LILLY MCCULLERS-JACKSON (OWNER ADMINISTRATOR) |
| Mailing Address: | 228 Gailridge Ln Wendell |
| State: | NC US |
| Postal Code: | 275917901 |
| Phone Number: | 9192669876 |
| Fax Number: | 9192667901 |
| NPI Enumeration Date: | 03/16/2007 |
| NPI Last Update Date: | 07/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 06/03/2008 |
| NPI Reactivation Date: | 07/09/2008 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | MHL 092 460 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |