Organization
COUNTRY LAYNE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDETRA M SAMPSON (OWNER)
(910) 740-3575
Entity
Organization
Contact information
Practice address
42 THREE HUNT'S DR, PEMBROKE, NC 28372-8998
(910) 740-3575
(910) 521-7435
Mailing address
PO BOX 270, PEMBROKE, NC 28372-0270
(910) 740-3575
(910) 521-7435
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
MHI078153
NC
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
MHL078153
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8301032
—
NC
05
—
8301032R
—
NC
Enumeration date
01/18/2007
Last updated
01/30/2009
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