Provider Demographics
NPI:1982839569
Name:COUNTRY COMFORT CRCF
Entity Type:Organization
Organization Name:COUNTRY COMFORT CRCF
Other - Org Name:CLIFFORD A. COUNTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-735-9777
Mailing Address - Street 1:204 JOE APREE CIR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8807
Mailing Address - Country:US
Mailing Address - Phone:803-735-9777
Mailing Address - Fax:
Practice Address - Street 1:204 JOE APREE CIR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8807
Practice Address - Country:US
Practice Address - Phone:803-735-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCRC-1467320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness