Healthcare Provider Details

I. General information

NPI: 1588591556
Provider Name (Legal Business Name): COUNTRY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 HIGHWAY 2 STE 101A
PRIEST RIVER ID
83856-6097
US

IV. Provider business mailing address

92 YARROW LN
NEWPORT WA
99156-9122
US

V. Phone/Fax

Practice location:
  • Phone: 509-671-0212
  • Fax:
Mailing address:
  • Phone: 509-671-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAWAI L TOWRY
Title or Position: OWNER
Credential:
Phone: 509-671-0212