Organization
COUNTRY PLACE VILLAGE I LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN K CLARKE (PRESIDENT CEO)
(903) 566-8500
Entity
Organization
Contact information
Practice address
2103 CHANDLER ST, KILGORE, TX 75662-3741
(903) 984-7827
Mailing address
PO BOX 479, TYLER, TX 75710-0479
(903) 566-8500
(903) 566-8506
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
100561
TX
Other
Enumeration date
04/06/2007
Last updated
08/22/2020
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