Organization
COUNTRY TIME INN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARLES E TREFZGER JR. (MANAGER)
(828) 322-5535
Entity
Organization
Contact information
Practice address
602 BREVARD ST, KINGS MOUNTAIN, NC 28086-8692
(704) 739-2760
(704) 739-6252
Mailing address
PO BOX 2568, HICKORY, NC 28603-2568
(828) 322-5535
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
HAL036018
NC
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805757
—
NC
Enumeration date
09/23/2005
Last updated
07/28/2021
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