1962527176 NPI number — COUNTRY LIVING SKILLED NURSING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962527176 NPI number — COUNTRY LIVING SKILLED NURSING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTRY LIVING SKILLED NURSING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962527176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7520 OHIO RIVER RD
Provider Second Line Business Mailing Address:
PO BOX 215
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45662-5669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-574-4239
Provider Business Mailing Address Fax Number:
740-574-6347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7520 OHIO RIVER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-574-4239
Provider Business Practice Location Address Fax Number:
740-574-6347
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINHAM
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-574-4239

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  251 E00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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