National Provider Identifier Database

COUNTRY LIVING GUEST HOME INC
Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.


Contact Information

COUNTRY LIVING GUEST HOME, INC.
3650 CHERRY ROAD
WASHINGTON, NC27889
Phone: 252-975-3741
Fax: 252-975-3044
Website:
Specialty Taxonomy Code
* Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320600000X
Adult Care Home 311ZA0620X
Community/Behavioral Health 251S00000X
Non-emergency Medical Transport (VAN) 343900000X

* Indicates primary specialty

NPI Profile & details for COUNTRY LIVING GUEST HOME, INC.

NPI Number 1720798804
Legal business name
LBN
COUNTRY LIVING GUEST HOME, INC.
Authorized official KELLIE HARDISON - (ADMINISTRATOR)
Entity Organization
Organization subpart Yes
Enumeration date 11/30/2022
Last updated 01/26/2023 - About 3 years ago
Sole proprietor1 Not specified
Identifiers n/a

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.

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