Country Manor Personal Care Home, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

PCH008305 Issued in GA

Legal business name

COUNTRY MANOR PERSONAL CARE HOME, INC

Practice address

173 N Hulin Ave
Tignall, GA 30668-2505

Phone

(706) 285-3070

Fax

(706) 285-3071

NPI assigned

Mar 19, 2014

Last updated

Mar 19, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Renae Roberson, RN

Title

Owner/ Administrator

Phone

(706) 285-3070

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395187200000",
    "number": "1649697442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 N HULIN AVE",
            "city": "TIGNALL",
            "state": "GA",
            "postal_code": "306682505",
            "telephone_number": "706-285-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 N HULIN AVE",
            "city": "TIGNALL",
            "state": "GA",
            "postal_code": "306682505",
            "telephone_number": "706-285-3070",
            "fax_number": "706-285-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY MANOR PERSONAL CARE HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2014-03-19",
        "status": "A",
        "authorized_official_last_name": "ROBERSON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RENAE",
        "authorized_official_title_or_position": "OWNER/ ADMINISTRATOR",
        "authorized_official_telephone_number": "706-285-3070",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "PCH008305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Tignall, GA
• Providers in Tignall, GA by specialty
• Assisted Living Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; 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.