Organization
COUNTRY MANOR ESTATES PERSONAL CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FAYE L GROOVER (OWNER)
(478) 781-9387
Entity
Organization
Contact information
Practice address
1487 ALLEN RD, MACON, GA 31216-5817
(478) 781-9387
(478) 781-9387
Mailing address
1487 ALLEN RD, MACON, GA 31216-5817
(478) 781-9387
(478) 781-9387
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
011-01-058-1
GA
Other
Enumeration date
11/04/2010
Last updated
11/04/2010
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