OrganizationActive
Country Manor Assisted Living & Retirement Home, LLC
NPI 1104247717 · Assisted Living Facility (Mental Illness) · Port Orange, FL
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
Practice location
1152 Old Hammock Rd
Port Orange, FL 32129-5016
Phone: (386) 265-5935
Fax: (386) 265-5937
Approximate (ZIP-level) locationGet directions
Mailing address
1152 Old Hammock Rd
Port Orange, FL 32129-5016
Registry dates
- Enumerated
- 2013-12-27
- Last updated
- 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.