Organization
COUNTRY CLUB RETIREMENT CENTER LLC
Active
Organization
COUNTRY CLUB RETIREMENT CENTER LLC
Active
Other names
Country Club Retirement Center III
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ADAMIC (CORP CONTROLLER)
(330) 239-3597
Entity
Organization
Contact information
Practice address
925 E 26TH ST, ASHTABULA, OH 44004-5061
(440) 992-0022
Mailing address
925 E 26TH ST, ASHTABULA, OH 44004-5061
(440) 992-0022
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1794R
LICENSURE
OH
Enumeration date
02/01/2021
Last updated
02/01/2021
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