Organization
COUNTRYWOOD MANOR ASSISTED LIVING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH A LONG (PRESIDENT)
(662) 401-8930
Entity
Organization
Contact information
Practice address
145 WATSON DR, MANTACHIE, MS 38855-8381
(662) 282-7808
(662) 282-7738
Mailing address
PO BOX 4150, TUPELO, MS 38803-4150
(662) 322-4636
(662) 840-3311
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
11/19/2020
Last updated
11/19/2020
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