COUNTRY CARE INC NPI 1003001033

Assisted Living Facility in Cottonwood, AZ

About COUNTRY CARE INC

Country Care Inc is a provider in Cottonwood, AZ. The NPI number assigned to this provider is 1003001033. The practitioner's primary taxonomy code is Assisted Living Facility (310400000X). The provider is registered as an organization and their NPI record was last updated 11 years ago.

NPI

1003001033

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameCOUNTRY CARE INC
Provider Location Address3980 E CASSIE LANE COTTONWOOD, AZ 86326 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address5302 N 43RD PLACE PHOENIX, AZ 85018 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date09-12-2007 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date09-12-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Primary Taxonomy

Taxonomy Code310400000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationAssisted Living Facility
TypeNursing & Custodial Care Facilities
License No.ALH4144
License StateAZ
Taxonomy DescriptionA facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Business Address

COUNTRY CARE INC
3980 E CASSIE LANE
COTTONWOOD, AZ
ZIP 86326
Phone: (928) 649-0434
Fax: (928) 649-0238

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Mailing Address

COUNTRY CARE INC
5302 N 43RD PLACE
PHOENIX, AZ
ZIP 85018
Phone: (928) 274-0702
Fax: (602) 808-9186

Authorized Official

Authorized Official NameMR. MICHAEL THOMAS HARRIS Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitlePRESIDENT
Authorized Official Phone(928) 274-0702
Previous NPI
1003001025
Next NPI
1003001041