Provider Demographics
NPI:1548095565
Name:COUNTRY CARE ASSISTED LIVING
Entity type:Organization
Organization Name:COUNTRY CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:TIFFANY
Authorized Official - Last Name:FAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-430-8117
Mailing Address - Street 1:4735 W LUDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622-9796
Mailing Address - Country:US
Mailing Address - Phone:989-430-8117
Mailing Address - Fax:
Practice Address - Street 1:4735 W LUDINGTON DR
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-9796
Practice Address - Country:US
Practice Address - Phone:989-588-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility