# COUNTRY LIVING GUEST HOME, INC.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COUNTRY LIVING GUEST HOME, INC.
- **Other names:** Country Living: Hickory House
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467164145
- **Legal business name:** COUNTRY LIVING GUEST HOME, INC.
- **Authorized official:** MISS KELLIE MICHELLE HARDISON MSW, LCSW, QP,ADMIR (ADMINISTRATOR)
- **Authorized official phone:** (252) 975-3741

## Contact information

- **Practice address:** 3636 CHERRY ROAD, WASHINGTON, NC 27889
- **Practice address phone:** (252) 975-3741
- **Practice address fax:** (252) 975-3044
- **Mailing address:** 217 EAST 9TH STREET, WASHINGTON, NC 27889
- **Mailing address phone:** (252) 975-3741
- **Mailing address fax:** (252) 975-3044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 12/14/2022
- **Last updated:** 01/26/2023