COUNTRY CLUB II (NPI# 1316087992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316087992 |
| Entity Type | Organization |
| Organization Name | COUNTRY CLUB II |
| Practice Address |
4011 Old Courthouse Rd Sophia NC 27350-8866 |
| Mailing Address |
1324 Coltrane Mill Rd Randleman NC 27317-8020 |
| Practice Telephone | 3366746293 |
| Mailing Telephone | 3366746293 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. PEARLIE M. BULLOCK (ADMINISTRATOR) |
| Authorized Official Telephone | 3366746293 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 177F00000X | Lodging | FCL076031 | NC | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | FCL076031 | 05 | |
| NC | MLH076085 | 05 |
| Street Address |
4011 OLD COURTHOUSE RD |
| City | SOPHIA |
| State | NC |
| Zip Code | 27350-8866 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801084108 | Debra Lanier Tatum | Counselor | 6658 Flint Hill Rd, Sophia, NC 27350-8120 | 2007-10-11 |
| 1144827585 | Catherine B Sullivan | Registered Nurse | 4111 Beeson Farm Rd, Sophia, NC 27350-8451 | 2020-10-08 |
| 1447698659 | Youth Unlimited Inc | Community/Behavioral Health | 2869 Youth Unlimited Dr, Sophia, NC 27350-8460 | 2013-06-10 |
| 1457372088 | Melanie Coble Paschal | Social Worker | 2872 Youth Unlimited Dr, Sophia, NC 27350-8460 | 2006-07-21 |
| 1629416003 | Youth Unlimited Inc | Community Based Residential Treatment Facility, Mental Illness | 2872 Youth Unlimited Dr, Sophia, NC 27350-8460 | 2013-06-07 |
| 1487092607 | Youth Unlimited Inc | Community Based Residential Treatment Facility, Mental Illness | 2748 Youth Unlimited Dr, Sophia, NC 27350-8461 | 2013-06-10 |
| 1588002703 | Youth Unlimited Inc | Residential Treatment Facility, Emotionally Disturbed Children | 2780 Youth Unlimited Dr, Sophia, NC 27350-8461 | 2013-06-10 |
| 1336473479 | Jane Elizabeth Hoonhout | Nurse Practitioner | 2962 Youth Unlimited Dr, Sophia, NC 27350-8481 | 2009-09-22 |
| 1336543776 | Keisha Mccleese Moore | Counselor | 2962 Youth Unlimited Dr, Sophia, NC 27350-8481 | 2014-10-14 |
| 1073951281 | Youth Unlimited Inc | Counselor | 2962 Youth Unlimited Dr, Sophia, NC 27350-8481 | 2013-06-10 |
| Find all providers in zip 27350 | ||||
| Taxonomy Code | 177F00000X |
| Grouping | Other Service Providers |
| Classification | Lodging |
| A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831701903 | Another Chance: House of Refuge | Lodging | 1708 Chambers Dr Apt 15, Matthews, NC 28105-4782 | 2020-08-20 |
| 1003107277 | The Manor At Riverbrooke | Lodging | 3120 Tuckland Drive, Raleigh, NC 27610-5257 | 2011-04-22 |
| 1306161013 | Guiding Star Health Care Adult Group Home | Lodging | 2809 Huntington Ct, Rocky Mount, NC 27803-1641 | 2010-04-06 |
| 1285866319 | The Manor At Edgewater | Lodging | 1038 Stormy Ln, Raleigh, NC 27610-6074 | 2009-08-24 |
| 1528204286 | Kirk Matthew Ledoux | Lodging | 305 Causby Ln, Hendersonville, NC 28791-8721 | 2008-12-31 |
| 1114191921 | Carillon Assisted Living of Lincolnton, LLC | Lodging | 440 Salem Church Road, Lincolnton, NC 28092-8856 | 2008-04-14 |
| 1790966554 | The Manor At Coventry Creek | Lodging | 5124 Werribee Dr, Raleigh, NC 27616-5546 | 2007-11-21 |
| 1801081310 | Lee's Family Care Home | Lodging | 945 Vaiden Road, Louisburg, NC 27549-8096 | 2007-09-07 |
| 1467650036 | Pittman Family Care | Lodging | 47 Piney Haven Dr, Bakersville, NC 28705-0525 | 2007-07-05 |
| 1235334194 | Suzan Lynne Booker | Lodging | 1424 Huntdell Main Dr, Wendell, NC 27591-7254 | 2007-06-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.