Organization
COUNTRYSIDE MANOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILES E STANLEH (ADMINISTRATOR)
(336) 643-6301
Entity
Organization
Contact information
Practice address
7700 US HIGHWAY 158, STOKESDALE, NC 27357-9346
(336) 643-6301
(336) 643-9906
Mailing address
7700 US HIGHWAY 158, PO BOX 829, STOKESDALE, NC 27357-9346
(336) 643-6301
(336) 643-9906
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
NH0226
NC
313M00000X
Nursing Facility/Intermediate Care Facility
NH0226
NC
314000000X
Skilled Nursing Facility
Primary
NH0226
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3415390
—
NC
05
—
3416145
—
NC
Enumeration date
09/16/2005
Last updated
09/11/2025
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