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Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Other names
Country Living Estates
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KELLIE MICHELLE HARDISON MSW, LCSW (ADMINISTRATOR)
(252) 975-3741
Entity
Organization
Contact information
Practice address
424 WHARTON STATION ROAD, WASHINGTON, NC 27889-8472
(252) 975-3741
(252) 975-3044
Mailing address
217 EAST 9TH STREET, WASHINGTON, NC 27889-8472
(252) 975-3741
(252) 975-3044
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
311ZA0620X
Adult Care Home Facility
—
NULL
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
Other
Enumeration date
01/03/2007
Last updated
10/12/2023
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