Country Manor Assisted Living & Retirement Home, LLC
NPI 1104247717 · Assisted Living Facility (Mental Illness) · Port Orange, FL
Country Manor Assisted Living & Retirement Home, LLC is a Assisted Living Facility (Mental Illness) organization in Port Orange, FL (NPI 1104247717).
Provider details
- NPI number
- 1104247717
- Entity type
- Organization
- Primary specialty
- Assisted Living Facility (Mental Illness)Nursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Arnulfo Simondac, Administrator(386) 589-6252
- License
- 12025 (FL)
Specialties & taxonomies
Nursing & Custodial Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2013-12-27
- Last updated
- 2013-12-27
Frequently asked questions
- What is Country Manor Assisted Living & Retirement Home, LLC's NPI number?
- Country Manor Assisted Living & Retirement Home, LLC's National Provider Identifier (NPI) is 1104247717, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Country Manor Assisted Living & Retirement Home, LLC?
- Country Manor Assisted Living & Retirement Home, LLC is classified in the NPPES registry as Assisted Living Facility (Mental Illness) (Nursing & Custodial Care Facilities).
- Where is Country Manor Assisted Living & Retirement Home, LLC located?
- Country Manor Assisted Living & Retirement Home, LLC's practice location on file with NPPES is 1152 Old Hammock Rd, Port Orange, FL 32129-5016.
- What is Country Manor Assisted Living & Retirement Home, LLC's phone number?
- The practice phone number listed in the NPPES registry for Country Manor Assisted Living & Retirement Home, LLC is (386) 265-5935.
- Who is the authorized official for Country Manor Assisted Living & Retirement Home, LLC?
- The authorized official listed on Country Manor Assisted Living & Retirement Home, LLC's NPPES record is Arnulfo Simondac, Administrator. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Country Manor Assisted Living & Retirement Home, LLC's NPI active?
- Yes — Country Manor Assisted Living & Retirement Home, LLC's NPI (1104247717) is active in the NPPES registry as of the last update on 2013-12-27.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.