# 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
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912064064
- **Authorized official:** ANGELA CARROW HARDISON (OWNER)
- **Authorized official phone:** (252) 975-3741

## Contact information

- **Practice address:** 3094 MARKET STREET EXTENSION, WASHINGTON, NC 27889-8126
- **Practice address phone:** (252) 975-3741
- **Practice address fax:** (252) 975-3044
- **Mailing address:** 217 EAST 9TH STREET, WASHINGTON, NC 27889-8126
- **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 | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 01/01/2007
- **Last updated:** 06/03/2020