Organization
COUNTRY LIVING CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERRI L MAYO (ADMINISTRATOR)
(641) 484-3561
Entity
Organization
Contact information
Practice address
2840 K AVE, TOLEDO, IA 52342-9405
(641) 484-3561
(641) 484-3651
Mailing address
2840 K AVE, TOLEDO, IA 52342-9405
(641) 484-3561
(641) 484-3651
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
R419
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0894188
—
IA
Enumeration date
05/20/2008
Last updated
05/20/2008
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