Country Manor Personal Care Home, Inc
Organization Active NPI Assisted Living Facility · Tignall, GA
NPI 1649697442 · NPPES record last updated Mar 19, 2014
Key facts
- NPI
- 1649697442
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- PCH008305 (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
- Organization subpart
- No
Authorized official
- Name
- Mrs. Angela Renae Roberson, RN
- Title
- Owner/ Administrator
- Phone
- (706) 285-3070
National Provider Directory
Locations
173 N Hulin Ave
Tignall, GA 30668
Phone (706) 285-3070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | PCH008305 | GA | Yes |
Addresses
Primary practice location
173 N Hulin Ave
Tignall, GA 30668-2505
Mailing address
173 N Hulin Ave
Tignall, GA 30668-2505
Phone (706) 285-3070
Other providers in Tignall, GA
- Tena Austin Blakey
- Charlie Van Diviere LTD
- Chas Van Diviere LTD
- David Manning Stubbs
- The Armour House
- Tignall Assisted Living, LLC
- Tynisha Walton
All providers in Tignall, GA · Assisted Living Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.