Organization
COUNTRY OAKS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA SONG (OWNER/MANAGER)
(815) 721-1189
Entity
Organization
Contact information
Practice address
544 W NIDO AVE, MESA, AZ 85210-7572
(815) 721-1189
Mailing address
1640 W LACEWOOD PL, PHOENIX, AZ 85045-0813
(815) 721-1189
(480) 656-7676
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
01/02/2026
Last updated
01/02/2026
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