Provider Demographics
NPI:1235738014
Name:COUNTRY LIVING
Entity Type:Organization
Organization Name:COUNTRY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MONTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-858-6327
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45630-0175
Mailing Address - Country:US
Mailing Address - Phone:740-464-8973
Mailing Address - Fax:740-876-4831
Practice Address - Street 1:13028 US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-8909
Practice Address - Country:US
Practice Address - Phone:740-858-6327
Practice Address - Fax:740-876-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility