Organization · Type 2 NPI

Country Living Guest Home, Inc.

Adult Care Home Facility · Washington, NC

NPI number 1467164145 Active

Practice location

3636 Cherry Road
Washington, NC 27889

Call (252) 975-3741 Map

Fax (252) 975-3044

Mailing address

217 East 9th Street
Washington, NC 27889

Specialties and licenses

Taxonomy	Code	License
Community/Behavioral Health Agency	251S00000X	None listed
Adult Care Home Facility Primary	311ZA0620X	None listed
Non-emergency Medical Transport (VAN)	343900000X	None listed

Adult Care Home Facility: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

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NPI record

NPI: 1467164145
Entity type: Organization (Type 2)
Issued: Dec 14, 2022
Last updated: Jan 26, 2023
Status: Active
Subpart: Yes of Country Living Guest Home, Inc.

Other names

<unavail>
Country Living: Hickory House · doing business as

Authorized official

Miss Kellie Michelle Hardison, MSW, LCSW, QP, ADMIR
Administrator
(252) 975-3741

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1467164145

Country Living Guest Home, Inc.'s National Provider Identifier is 1467164145, issued on Dec 14, 2022. The primary taxonomy on file is Adult Care Home Facility (311ZA0620X), and the practice location is in Washington, NC. The record was last updated on Jan 26, 2023.