# COUNTRY PINES INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Country Pines \#1
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497968762
- **Authorized official:** MR. KENNETH MICHAEL SAULS SR. BS BUSINESS (VICE PRESIDENT)
- **Authorized official phone:** (919) 778-4009

## Contact information

- **Practice address:** 2307 N BESTON RD, LA GRANGE, NC 28551-8627
- **Practice address phone:** (919) 778-4009
- **Practice address fax:** (919) 778-4009
- **Mailing address:** 2307 N BESTON RD, LA GRANGE, NC 28551-8627
- **Mailing address phone:** (919) 778-4009
- **Mailing address fax:** (919) 778-4009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL096117 | NC | Yes |
| 320800000X | Mental Illness Community Based Residential Treatment Facility | MHL096117 | NC | — |

## Other

- **Enumeration date:** 05/07/2007
- **Last updated:** 09/04/2007