Organization
COUNTRYSIDE VILLAGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL CHRYLL BATEMAN (PRESIDENT)
(336) 917-4799
Entity
Organization
Contact information
Practice address
5383 US HIGHWAY 117 N, PIKEVILLE, NC 27863-9443
(919) 242-6369
(919) 242-9884
Mailing address
3505 PRIMROSE AVE, GREENSBORO, NC 27408-3192
(336) 617-4799
(336) 617-4799
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
06/02/2011
Last updated
06/02/2011
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