Provider Demographics
NPI:1609991652
Name:COUNTRY CHRISTIAN CARE INC
Entity Type:Organization
Organization Name:COUNTRY CHRISTIAN CARE INC
Other - Org Name:ALZHEIRMERS DEMENTIA ASSISTED LIVING CRCF
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ZABOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:759C97 ADMINISTRATOR
Authorized Official - Phone:864-972-1072
Mailing Address - Street 1:207 FARM HOUSE LANE
Mailing Address - Street 2:
Mailing Address - City:FAIR PLAY
Mailing Address - State:SC
Mailing Address - Zip Code:29643
Mailing Address - Country:US
Mailing Address - Phone:864-972-1072
Mailing Address - Fax:864-972-1072
Practice Address - Street 1:207 FARM HOUSE LANE
Practice Address - Street 2:
Practice Address - City:FAIR PLAY
Practice Address - State:SC
Practice Address - Zip Code:29643
Practice Address - Country:US
Practice Address - Phone:864-972-1072
Practice Address - Fax:864-972-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCRC 1401OtherCRCF