# COUNTRY TIME INN LLC

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

## Provider details

- **NPI number:** 1538155643
- **Authorized official:** MRS. CHARLES E TREFZGER JR. (MANAGER)
- **Authorized official phone:** (828) 322-5535

## Contact information

- **Practice address:** 602 BREVARD ST, KINGS MOUNTAIN, NC 28086-8692
- **Practice address phone:** (704) 739-2760
- **Practice address fax:** (704) 739-6252
- **Mailing address:** PO BOX 2568, HICKORY, NC 28603-2568
- **Mailing address phone:** (828) 322-5535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | HAL036018 | NC | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 09/23/2005
- **Last updated:** 07/28/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7805757 | — | NC |