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Organization
COUNTRY MANOR ASSISTED LIVING & RETIREMENT HOME, LLC
Active
Organization
COUNTRY MANOR ASSISTED LIVING & RETIREMENT HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ARNULFO SALGADO SIMONDAC (ADMINISTRATOR)
(386) 589-6252
Entity
Organization
Contact information
Practice address
1152 OLD HAMMOCK RD, PORT ORANGE, FL 32129-5016
(386) 265-5935
(386) 265-5937
Mailing address
1152 OLD HAMMOCK RD, PORT ORANGE, FL 32129-5016
(386) 265-5935
(386) 265-5937
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
12025
FL
Other
Enumeration date
12/27/2013
Last updated
12/27/2013
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