Healthcare Provider Details

I. General information

NPI: 1477409613
Provider Name (Legal Business Name): COUNTRY LIVING TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 YARROW LN
NEWPORT WA
99156-9122
US

IV. Provider business mailing address

92 YARROW LN
NEWPORT WA
99156-9122
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

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