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.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
320600000X | |||
Adult Care Home |
311ZA0620X | |||
Community/Behavioral Health |
251S00000X | |||
Non-emergency Medical Transport (VAN) |
343900000X |
| NPI Number | 1831809912 |
| LBN Legal business name | COUNTRY LIVING GUEST HOME, INC. |
| Authorized official | KELLIE HARDISON - (ADMINISTRATOR) |
| Entity | Organization |
| Organization subpart 1 | Yes |
| Enumeration date | 11/30/2022 |
| Last updated | 01/26/2023 - About 3 years ago |
| Identifiers | n/a |
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