Organization
COUNTRYSIDE MANOR LLC
Active
Other names
Countryside Manor
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PRICE (MEMBER)
(918) 967-9285
Entity
Organization
Contact information
Practice address
300 S THOMPSON RD, LAMAR, AR 72846-9423
(479) 754-2052
(479) 754-5745
Mailing address
300 S THOMPSON RD, LAMAR, AR 72846-9423
(479) 754-2052
(479) 754-5745
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
AR
Other
Enumeration date
02/07/2007
Last updated
02/19/2008
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