| NPI | 1730384009 |
|---|---|
| Doing Business As | THE MANOR AT SOUTHPORT |
| Entity Type | Organization |
| Authorized Contact | DOUGLAS K MITTLEIDER President 770-619-0866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IN 07-011276-1) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2020-08-22 |