Healthcare Provider Details

I. General information

NPI: 1477752749
Provider Name (Legal Business Name): COUNTRY COTTAGE NURSING OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N BENSING RD
HOBBS NM
88240-9254
US

IV. Provider business mailing address

306 W 7TH ST STE 415
FORT WORTH TX
76102-4905
US

V. Phone/Fax

Practice location:
  • Phone: 505-397-1113
  • Fax: 505-319-9180
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1060
License Number StateNM

VIII. Authorized Official

Name: CHARLES HARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 817-335-4111