Organization
COUNTRY PINES INC
Active
Other names
Country Pines #2
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH MICHAEL SAULS SR. BS BUSINESS (VICE PRESIDENT)
(919) 778-4009
Entity
Organization
Contact information
Practice address
2600 N BESTON RD, LAGRANGE, NC 28551-8627
(919) 778-1244
Mailing address
2307 N BESTON RD, LAGRANGE, NC 28551-8627
(919) 778-4009
(919) 778-4009
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL096115
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804004
—
NC
Enumeration date
05/22/2007
Last updated
08/22/2020
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