Organization
COUNTRY MANOR PERSONAL CARE HOME, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA RENAE ROBERSON RN (OWNER/ ADMINISTRATOR)
(706) 285-3070
Entity
Organization
Contact information
Practice address
173 N HULIN AVE, TIGNALL, GA 30668-2505
(706) 285-3070
(706) 285-3071
Mailing address
173 N HULIN AVE, TIGNALL, GA 30668-2505
(706) 285-3070
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
PCH008305
GA
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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