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Organization

COUNTRY CLUB II LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PEARLIE BULLOCK (ADMINISTRATOR)
(336) 312-2101
Entity
Organization

Contact information

Practice address
1339 COLTRANE MILL RD, RANDLEMAN, NC 27317-8020
(336) 312-2101
(336) 674-1692
Mailing address
1339 COLTRANE MILL RD, RANDLEMAN, NC 27317-8020
(336) 312-2101
(336) 674-1692

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary

Other

Enumeration date
07/30/2026
Last updated
07/30/2026
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