# COUNTRYWOOD FAMILY CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376801977
- **Authorized official:** MIA SMITH (ADMINISTRATOR)
- **Authorized official phone:** (919) 436-0343

## Contact information

- **Practice address:** 118 OLD YOGI LN, CLAYTON, NC 27520-6180
- **Practice address phone:** (919) 436-0343
- **Mailing address:** 118 OLD YOGI LN, CLAYTON, NC 27520-6180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | FCL-051-046 | NC | Yes |

## Other

- **Enumeration date:** 05/02/2012
- **Last updated:** 05/02/2012