Provider Demographics
NPI:1497873400
Name:COUNTRY LIVING HOME CARE
Entity Type:Organization
Organization Name:COUNTRY LIVING HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-574-4239
Mailing Address - Street 1:1501 STATE ROUTE 522 UNIT D
Mailing Address - Street 2:PO BOX 165
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-7815
Mailing Address - Country:US
Mailing Address - Phone:740-574-4239
Mailing Address - Fax:740-574-6347
Practice Address - Street 1:1501 STATE ROUTE 522 UNIT D
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-7815
Practice Address - Country:US
Practice Address - Phone:740-574-4239
Practice Address - Fax:740-574-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X-251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health