Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Other names
Country Living Estates
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KELLIE MICHELLE HARDISON MSW, LCSW (ADMINISTRATOR)
(252) 975-3741
Entity
Organization
Contact information
Practice address
424 WHARTON STATION ROAD, WASHINGTON, NC 27889-8472
(252) 975-3741
(252) 975-3044
Mailing address
217 EAST 9TH STREET, WASHINGTON, NC 27889-8472
(252) 975-3741
(252) 975-3044
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805416
—
NC
Enumeration date
01/03/2007
Last updated
10/12/2023
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