Organization
COUNTRYSIDE MANOR HEALTHCARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HERVEY LAWRENCE (ADMINISTRATOR)
(765) 649-4558
Entity
Organization
Contact information
Practice address
205 MARINE DR, ANDERSON, IN 46016-5937
(765) 649-4558
(765) 641-1239
Mailing address
205 MARINE DR, ANDERSON, IN 46016-5937
(765) 649-4558
(765) 641-1239
Taxonomy
Speciality
Code
Description
License number
State
3140N1450X
Pediatric Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/20/2006
Last updated
08/22/2020
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