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Organization
COUNTRY MANOR PERSONAL CARE HOME, INC
Active
Organization
COUNTRY MANOR PERSONAL CARE HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA RENAE ROBERSON RN (OWNER/ ADMINISTRATOR)
(706) 285-3070
Entity
Organization
Contact information
Practice address
173 N HULIN AVE, TIGNALL, GA 30668-2505
(706) 285-3070
(706) 285-3071
Mailing address
173 N HULIN AVE, TIGNALL, GA 30668-2505
(706) 285-3070
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
PCH008305
GA
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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