Provider Demographics
NPI:1114283967
Name:COUNTRY CLUB HOME CARE
Entity Type:Organization
Organization Name:COUNTRY CLUB HOME CARE
Other - Org Name:A BETTER LIVING HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:925-680-0300
Mailing Address - Street 1:2280 DIAMOND BLVD STE 580
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5734
Mailing Address - Country:US
Mailing Address - Phone:925-680-0300
Mailing Address - Fax:925-680-0331
Practice Address - Street 1:2280 DIAMOND BLVD STE 580
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5734
Practice Address - Country:US
Practice Address - Phone:925-680-0300
Practice Address - Fax:925-680-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health