| NPI | 1477610657 |
|---|---|
| Doing Business As | COUNTRY LIVING GUEST HOME #5 |
| Entity Type | Organization |
| Authorized Contact | KELLIE MICHELLE HARDISON Administrator 252-975-3741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251S00000X |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-11-21 |