25D2202896 CLIA NUMBER - COUNTRYWOOD MANOR ASSISTED LIVING

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Laboratory Demographics

CLIA Number: 25D2202896

Facility Name: COUNTRYWOOD MANOR ASSISTED LIVING

Facility Address:
145 WATSON DR
MANTACHIE, MS
ZIP 38855
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Facility Phone Number: 662 282-7808

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1104429398

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	25D2202896
LAB Type	Assisted Living Facility
Facility Name	COUNTRYWOOD MANOR ASSISTED LIVING
Street	145 WATSON DR
City	MANTACHIE
State	MS
ZIP	38855
Phone	662 282-7808
CertificateType	4
CertificateEffectiveDate	12/1/2022
CertificateExpirationDate	11/30/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024