Organization
COUNTRY LIVING GUEST HOME, INC.
Active
Other names
Country Living Guest Home #6
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
252 DAN TAYLOR RD, WASHINGTON, NC 27889
(252) 975-3741
(252) 975-3044
Mailing address
217 EAST 9TH STREET, WASHINGTON, NC 27889
(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
—
—
Other
Enumeration date
08/03/2010
Last updated
11/21/2023
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