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Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Parent organization
COUNTRY LIVING GUEST HOME, INC.
Other names
Country Living: Hickory House
Organization subpart
Yes
Provider details
NPI number
Legal business name
COUNTRY LIVING GUEST HOME, INC.
Authorized official
MISS KELLIE MICHELLE HARDISON MSW, LCSW, QP,ADMIR (ADMINISTRATOR)
(252) 975-3741
Entity
Organization
Contact information
Practice address
3636 CHERRY ROAD, WASHINGTON, NC 27889
(252) 975-3741
(252) 975-3044
Mailing address
217 EAST 9TH STREET, WASHINGTON, NC 27889
(252) 975-3741
(252) 975-3044
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
311ZA0620X
Adult Care Home Facility
Primary
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
Other
Enumeration date
12/14/2022
Last updated
01/26/2023
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