# COUNTRYSIDE MANOR, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992790810
- **Authorized official:** MILES E STANLEH (ADMINISTRATOR)
- **Authorized official phone:** (336) 643-6301

## Contact information

- **Practice address:** 7700 US HIGHWAY 158, STOKESDALE, NC 27357-9346
- **Practice address phone:** (336) 643-6301
- **Practice address fax:** (336) 643-9906
- **Mailing address:** 7700 US HIGHWAY 158, PO BOX 829, STOKESDALE, NC 27357-9346
- **Mailing address phone:** (336) 643-6301
- **Mailing address fax:** (336) 643-9906

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | NH0226 | NC | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH0226 | NC | — |
| 314000000X | Skilled Nursing Facility | NH0226 | NC | Yes |

## Other

- **Enumeration date:** 09/16/2005
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3415390 | — | NC |
| 05 | — | 3416145 | — | NC |