COUNTRY PINES INC (NPI# 1497968762) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497968762 |
| Entity Type | Organization |
| Organization Name | COUNTRY PINES INC |
| Other Organization Name | COUNTRY PINES #1 |
| Practice Address |
2307 N Beston Rd La Grange NC 28551-8627 |
| Practice Telephone | 9197784009 |
| Practice Fax Number | 9197784009 |
| Mailing Telephone | 9197784009 |
| Mailing Fax Number | 9197784009 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-09-04 |
| Authorized Official Name | MR. KENNETH MICHAEL SAULS SR. (VICE PRESIDENT) |
| Authorized Official Telephone | 9197784009 |
| Authorized Official Credential | BS BUSINESS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320800000X | Community Based Residential Treatment Facility, Mental Illness | MHL096117 | NC | Residential Treatment Facilities |
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MHL096117 | NC | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | COMM SUPPORT | 8301207 | 01 |
| NC | CAP | 3409221 | 01 |
| NC | 7804027 | 05 |
| Other Name | Type Code |
|---|---|
| Country Pines #1 | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588873764 | Country Pines Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2600 N Beston Rd, Lagrange, NC 28551-8627 | 2007-05-22 |
| 1467672535 | Country Pines Inc | Community Based Residential Treatment Facility, Mental Illness | 2308 Oakdale Rd, La Grange, NC 28551-8627 | 2007-04-30 |
| Street Address |
2307 N BESTON RD |
| City | LA GRANGE |
| State | NC |
| Zip Code | 28551-8627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992229215 | Christopher Webster | Physical Therapist | 3870 Falling Creek Road, Legrange, NC 28551 | 2017-07-28 |
| 1437527082 | Tanger Lee Jones | Counselor | 197 Brook Meadow Lane, Lagrange, NC 28551 | 2015-09-11 |
| 1235362161 | Daniel's Choices Youth Development, Inc. | Community/Behavioral Health | 525 Arba Jason Rd., La Grange, NC 28551 | 2009-08-26 |
| 1518942135 | Marjorie R Rachide | Nurse Practitioner | 101 South Carey Street, Lagrange, NC 28551 | 2005-12-07 |
| 1669611471 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 407 W. Washington Street, Lagrange, NC 28551-1623 | 2009-02-18 |
| 1447499330 | Nova Ic, Inc. | Intermediate Care Facility, Mentally Retarded | 405 W Washington St, La Grange, NC 28551-1623 | 2009-02-17 |
| 1629259676 | Advantage Care of North Carolina, LLC | Case Management | 111 S Caswell St, La Grange, NC 28551-1707 | 2007-11-19 |
| 1629118013 | Waters' Provider Care Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 104 W James St, La Grange, NC 28551-1727 | 2007-02-07 |
| 1568586808 | Ant Mary's Family Care | Custodial Care Facility | 127 E Railroad St, La Grange, NC 28551-1741 | 2007-03-19 |
| 1720063340 | Carl L Haynes Jr. | Family Medicine | 101 S Carey St, La Grange, NC 28551-1805 | 2005-12-07 |
| Find all providers in zip 28551 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598808743 | James-leach,inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 339 W Colorado St, La Grange, TX 78945-2207 | 2007-02-15 |
| 1629118013 | Waters' Provider Care Services, Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 104 W James St, La Grange, NC 28551-1727 | 2007-02-07 |
| 1043379340 | Rha Health Services Nc, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5840 Greenwood Dr, La Grange, NC 28551-6815 | 2006-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578160552 | Residential Option Serving Adolescents, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2316 Carved Tree Ln, Charlotte, NC 28262-3154 | 2020-10-03 |
| 1649895442 | Gaynelle Bolling | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 102 Mandarin Dr, Pikeville, NC 27863-0020 | 2020-06-08 |
| 1851913966 | Johnson Enrichment Services LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 221 Foxcroft Dr, Winston Salem, NC 27103-5313 | 2020-05-12 |
| 1881230795 | Walter Jason Young Jr. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 412 Rook Rd, Charlotte, NC 28216-3199 | 2019-11-26 |
| 1750935839 | Heavenly Touch Residential Care | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4720 Baileys Lake Rd Nw Apt 204, Concord, NC 28027-8576 | 2019-07-28 |
| 1073166245 | Making Kids Matter, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 409 Hunton Forest Dr Nw, Concord, NC 28027-0186 | 2019-07-17 |
| 1891357752 | New Hope for Tomorrow LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 528 Baldwin Rd, Burlington, NC 27217-1702 | 2019-07-01 |
| 1114490877 | Brenda Gail Cannon | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3105 Vico Ter, Raleigh, NC 27610-5951 | 2019-01-05 |
| 1356813455 | Lamesha Marshall | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3335 Avalon Ave, Charlotte, NC 28208-3378 | 2018-12-31 |
| 1487131074 | Ronald Anthony Benjamin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 1594 Candace Ridge Dr, Greensboro, NC 27406-8595 | 2018-07-26 |
| 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.