Countrywood Manor Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRYWOOD MANOR ASSISTED LIVING, INC.

Practice address

145 Watson Dr
Mantachie, MS 38855-8381

Phone

(662) 282-7808

Fax

(662) 282-7738

NPI assigned

Nov 19, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth A Long

Title

President

Phone

(662) 401-8930

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1104429398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4150",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388034150",
            "telephone_number": "662-322-4636",
            "fax_number": "662-840-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 WATSON DR",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388558381",
            "telephone_number": "662-282-7808",
            "fax_number": "662-282-7738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYWOOD MANOR ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-401-8930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mantachie",
            "affiliation": "N",
            "endpointDescription": "Local Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "145 Watson Dr",
            "city": "Mantachie",
            "state": "MS",
            "country_code": "US",
            "postal_code": "388558381",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Assisted Living Facility in Mantachie, MS
• Providers in Mantachie, MS by specialty
• Assisted Living Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.