Healthcare Provider Details

I. General information

NPI: 1518141506
Provider Name (Legal Business Name): COUNTRY LOVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 HOLCOMB RD
BOONVILLE NC
27011-8834
US

IV. Provider business mailing address

2632 HOLCOMB RD
BOONVILLE NC
27011-8834
US

V. Phone/Fax

Practice location:
  • Phone: 336-287-0208
  • Fax:
Mailing address:
  • Phone: 336-287-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHERRY STOKES DARNELL
Title or Position: CO-OWNER
Credential:
Phone: 336-287-0208