Provider Demographics
NPI:1417035346
Name:COUNTRY VIEW CARE HOME
Entity Type:Organization
Organization Name:COUNTRY VIEW CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-665-6068
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:TX
Mailing Address - Zip Code:78057-0186
Mailing Address - Country:US
Mailing Address - Phone:830-665-6068
Mailing Address - Fax:830-663-5232
Practice Address - Street 1:1060 W FM 462
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:TX
Practice Address - Zip Code:78057-3505
Practice Address - Country:US
Practice Address - Phone:830-665-6068
Practice Address - Fax:830-663-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000716310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN