COUNTRY MANOR ASSISTED LIVING & RETIREMENT HOME, LLC
NPI 1104247717
Assisted Living Facility - Assisted Living, Mental Illness in Port Orange, FL

Q: What is Country Manor Assisted Living & Retirement Home, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

Active since December 27, 2013

1152 OLD HAMMOCK RD, PORT ORANGE, FL 32129(386) 265-5935(386) 265-5937 Get Directions Write a Review

NPPES record last updated: December 27, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Country Manor Assisted Living & Retirement Home, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY MANOR ASSISTED LIVING & RETIREMENT HOME, LLC (NPI 1104247717) is a healthcare organization registered as an assisted living, mental illness in Port Orange, Florida and active in the NPI registry since December 2013. The organization lists Arnulfo Salgado Simondac, Administrator, as its authorized official.

NPPES Registry Identity

NPI1104247717

Entity TypeOrganization

Primary Taxonomy3104A0625X

Legal Business NameCOUNTRY MANOR ASSISTED LIVING & RETIREMENT HOME, LLC

Location Address1152 OLD HAMMOCK RDPort Orange, FL 32129-5016

Mailing Address1152 Old Hammock RdPort Orange, FL 32129-5016 · (386) 265-5935 · Fax (386) 265-5937

Phone(386) 265-5935

Fax(386) 265-5937

Organization SubpartNo

Authorized OfficialArnulfo Salgado SimondacAdministrator · (386) 589-6252

Enumeration DateDecember 27, 2013

✔ NPI 1104247717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living Facility · Assisted Living, Mental IllnessNursing & Custodial Care Facilities

Taxonomy Code3104A0625X

License✔ Licensed in FL · 12025

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.

1152 OLD HAMMOCK RD, Port Orange, FL 32129

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Manor Assisted Living & Retirement Home, LLC's NPI number?

The NPI number for Country Manor Assisted Living & Retirement Home, LLC is 1104247717. It was assigned to this organization in the NPPES registry on December 27, 2013.

Where is Country Manor Assisted Living & Retirement Home, LLC located?

Country Manor Assisted Living & Retirement Home, LLC is located at 1152 Old Hammock Rd, Port Orange, FL 32129. The listed phone number is (386) 265-5935.

What is Country Manor Assisted Living & Retirement Home, LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility, specializing in Assisted Living, Mental Illness, with taxonomy code 3104A0625X.

When was this NPI record last updated?

The NPPES record for Country Manor Assisted Living & Retirement Home, LLC was last updated on December 27, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.