Provider Demographics
NPI:1477195733
Name:COUNTRY CARE ASSISTED LIVING HOME FOR THE ELDERLY
Entity Type:Organization
Organization Name:COUNTRY CARE ASSISTED LIVING HOME FOR THE ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-835-3910
Mailing Address - Street 1:13100 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-9428
Mailing Address - Country:US
Mailing Address - Phone:559-835-3910
Mailing Address - Fax:559-891-0359
Practice Address - Street 1:13100 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-9428
Practice Address - Country:US
Practice Address - Phone:559-835-3910
Practice Address - Fax:559-891-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility