Provider Demographics
NPI:1215376785
Name:COUNTRY VIEW SENIOR LIVING
Entity Type:Organization
Organization Name:COUNTRY VIEW SENIOR LIVING
Other - Org Name:JOY GIVERS SENIOR HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-499-6978
Mailing Address - Street 1:PO BOX 4234
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-4234
Mailing Address - Country:US
Mailing Address - Phone:231-499-6978
Mailing Address - Fax:
Practice Address - Street 1:7438 N LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-8223
Practice Address - Country:US
Practice Address - Phone:231-499-6978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL280095116320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities