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

Countrywood Manor Assisted Living, Inc

Organization Assisted Living Facility · NPI 1104429398

Countrywood Manor Assisted Living, Inc is an Assisted Living Facility in Mantachie, Mississippi. Registered with an NPI since 2020.

In the registry since
2020
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

145 Watson Dr
Mantachie, MS 38855-8381
Phone: (662) 282-7808
Fax: (662) 282-7738
Show map & directions

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

Specialties & licences

Assisted Living Facility (primary) Taxonomy 310400000X

Record details

NPI number1104429398
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kenneth Long — President · (662) 401-8930
NPI enumeratedNovember 19, 2020
Last updated in NPPESNovember 19, 2020
Certification dateNovember 19, 2020
Mailing addressPo Box 4150, Tupelo, MS 38803-4150