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General NPI Number Information
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NPI Number | 1609248855
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Entity Type | Organization
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Legal Business Name | COUNTRY LIVING ESTATES, INC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 4761 DRAUGHON RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-8480
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Country | US
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Telephone | 910-484-1701
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Fax | 910-484-1703
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Provider Business Mailing Address
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Address Line | 4761 DRAUGHON RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28312-8480
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Country | US
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Telephone | 910-484-1701
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Fax | 910-484-1703
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HILDA MOORE
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Credential |
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Telephone | 910-484-1701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 344600000X
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Taxonomy Name | Taxi
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | NC
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