Provider Demographics
NPI:1063661155
Name:SUE'S COUNTRY HOME & CARE
Entity Type:Organization
Organization Name:SUE'S COUNTRY HOME & CARE
Other - Org Name:JAMMIE SUE DENNIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMMIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-665-5049
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:DEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:78016-0096
Mailing Address - Country:US
Mailing Address - Phone:830-665-5049
Mailing Address - Fax:830-665-5049
Practice Address - Street 1:195 PRIVATE ROAD 6623
Practice Address - Street 2:
Practice Address - City:DEVINE
Practice Address - State:TX
Practice Address - Zip Code:78016-0096
Practice Address - Country:US
Practice Address - Phone:830-665-5049
Practice Address - Fax:830-665-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXFOSTERCARE311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home