Organization
COUNTRY CLUB RETIREMENT CENTER IV, INC
Active
Other names
County Club Retirement Center
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ADAMIC (CORP CONTROLLER)
(330) 239-3597
Entity
Organization
Contact information
Practice address
55801 CONNO MARA DR, BELLAIRE, OH 43906-9698
(740) 676-2300
Mailing address
55801 CONNO MARA DR, BELLAIRE, OH 43906-9698
(740) 676-2300
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1858R
LICENSURE
OH
Enumeration date
02/01/2021
Last updated
02/01/2021
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