| NPI | 1275673642 |
|---|---|
| Doing Business As | COUNTRYSIDE MANOR |
| Entity Type | Organization |
| Authorized Contact | JUSTIN PRICE Member 918-967-9285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: AR 119695311) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-02-19 |