Provider Demographics
NPI:1235535188
Name:COUNTRY PLEASURES ASSISTED LIVING
Entity Type:Organization
Organization Name:COUNTRY PLEASURES ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-392-9284
Mailing Address - Street 1:1818 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-8984
Mailing Address - Country:US
Mailing Address - Phone:231-922-6849
Mailing Address - Fax:
Practice Address - Street 1:1818 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8984
Practice Address - Country:US
Practice Address - Phone:231-922-6849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility