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General NPI Number Information
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NPI Number | 1558581454
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Entity Type | Organization
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Legal Business Name | COUNTRY LIVING, INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 N 5TH AVE
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City | ANTHONY
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State | KS
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Zip | 67003-2134
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Country | US
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Telephone | 620-842-5858
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Fax | 620-842-5840
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Provider Business Mailing Address
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Address Line | 420 N 5TH AVE
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City | ANTHONY
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State | KS
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Zip | 67003-2134
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Country | US
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Telephone | 620-842-5858
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Fax | 620-842-5840
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Authorized Official
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Title or Position | OPERATOR
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Name | MRS. SHARON OWEN
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Credential | LPN
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Telephone | 620-842-5858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | N039004
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License Number State | KS
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