Organization
COUNTRYWOOD FAMILY CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIA SMITH (ADMINISTRATOR)
(919) 436-0343
Entity
Organization
Contact information
Practice address
118 OLD YOGI LN, CLAYTON, NC 27520-6180
(919) 436-0343
Mailing address
118 OLD YOGI LN, CLAYTON, NC 27520-6180
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
FCL-051-046
NC
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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