Provider Demographics
NPI:1922301969
Name:COUNTRY HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:COUNTRY HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-875-4551
Mailing Address - Street 1:401 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2630
Mailing Address - Country:US
Mailing Address - Phone:910-875-4551
Mailing Address - Fax:
Practice Address - Street 1:2908 COUNTRY HOME RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-7628
Practice Address - Country:US
Practice Address - Phone:910-875-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL 013-039311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home