Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Country Manor Assisted Living & Retirement Home, LLC

Organization Assisted Living Facility (Mental Illness) · NPI 1104247717

Country Manor Assisted Living & Retirement Home, LLC is an Assisted Living Facility (Mental Illness) in Port Orange, Florida. Licensed in Florida. Registered with an NPI since 2013.

Licensed in
FL
In the registry since
2013
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

1152 Old Hammock Rd
Port Orange, FL 32129-5016
Phone: (386) 265-5935
Fax: (386) 265-5937
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Assisted Living Facility (Mental Illness) (primary) Taxonomy 3104A0625X · Licence 12025 (FL)

Record details

NPI number1104247717
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Arnulfo Simondac — Administrator · (386) 589-6252
NPI enumeratedDecember 27, 2013
Last updated in NPPESDecember 27, 2013
Mailing address1152 Old Hammock Rd, Port Orange, FL 32129-5016