Provider Demographics
NPI:1326101759
Name:COUNTRY HERITAGE II, INC.
Entity Type:Organization
Organization Name:COUNTRY HERITAGE II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-965-8998
Mailing Address - Street 1:5769 CONNER RD
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2717
Mailing Address - Country:US
Mailing Address - Phone:770-965-8998
Mailing Address - Fax:770-965-5612
Practice Address - Street 1:5761 CONNER RD
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-2717
Practice Address - Country:US
Practice Address - Phone:770-967-3090
Practice Address - Fax:770-967-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility