# COUNTRYSIDE MANOR LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Countryside Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275673642
- **Authorized official:** JUSTIN PRICE (MEMBER)
- **Authorized official phone:** (918) 967-9285

## Contact information

- **Practice address:** 300 S THOMPSON RD, LAMAR, AR 72846-9423
- **Practice address phone:** (479) 754-2052
- **Practice address fax:** (479) 754-5745
- **Mailing address:** 300 S THOMPSON RD, LAMAR, AR 72846-9423
- **Mailing address phone:** (479) 754-2052
- **Mailing address fax:** (479) 754-5745

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | AR | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 02/19/2008