NPI 1104429398

Countrywood Manor Assisted Living, INC.

Organisation Assisted Living Facility Mantachie, MS

Practice location

Address: 145 Watson Dr, Mantachie, MS 38855-8381
Phone: (662) 282-7808
Fax: (662) 282-7738
Mailing address: PO Box 4150, Tupelo, MS 38803-4150

Authorised official

Name: Kenneth a Long
Title: President
Phone: (662) 401-8930

Registered specialties

Assisted Living Facility Primary

Nursing & Custodial Care Facilities Taxonomy 310400000X

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Registry record

NPI: 1104429398
Entity type: Organization
NPI issued: 19 Nov 2020
Record last updated: 19 Nov 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.