National Provider Identifier Database

COUNTRY CLUB II
Lodging

A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home.


Contact Information

COUNTRY CLUB II
4011 OLD COURTHOUSE RD
SOPHIA, NC27350-8866
Phone: 336-674-6293
Fax:
Website:
Specialty Taxonomy Code
* Lodging 177F00000X

* Indicates primary specialty

NPI Profile & details for COUNTRY CLUB II

NPI Number 1316087992
Legal business name
LBN
COUNTRY CLUB II
Authorized official PEARLIE BULLOCK - (ADMINISTRATOR)
Entity Organization
Organization subpart No
Enumeration date 02/06/2007
Last updated 08/22/2020 - About 6 years ago
Sole proprietor1 Not specified
Identifiers
  • NC License #: FCL076031
  • NC Medicaid: FCL076031
  • NC Medicaid: MLH076085

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for COUNTRY CLUB II

There are currently no reviews for COUNTRY CLUB II


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