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COUNTRY LIVING: HICKORY HOUSE
NPI 1467164145
Custodial Care Facility - Adult Care Home in Washington, NC

Active since December 14, 2022CLIA Certified · 3 labs
3636 CHERRY ROAD, WASHINGTON, NC 27889(252) 975-3741(252) 975-3044 Get Directions Write a Review

NPPES record last updated: January 26, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 26, 2023, Dec 14, 2022 (2 updates tracked since 2022).

About Country Living: Hickory House NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY LIVING: HICKORY HOUSE (NPI 1467164145) is a healthcare organization registered as an adult care home in Washington, North Carolina and active in the NPI registry since December 2022. The organization holds 3 active CLIA laboratory certificates and lists Kellie Michelle Hardison, Administrator, as its authorized official.

NPPES Registry Identity

NPI1467164145
Entity TypeOrganization
Primary Taxonomy311ZA0620X
Legal Business NameCOUNTRY LIVING GUEST HOME, INC.
Location Address3636 CHERRY ROADWashington, NC 27889
Mailing Address217 East 9th StreetWashington, NC 27889 · (252) 975-3741 · Fax (252) 975-3044
Phone(252) 975-3741
Fax(252) 975-3044
Organization SubpartYes
Authorized OfficialKellie Michelle HardisonAdministrator · (252) 975-3741
Enumeration DateDecember 14, 2022
Last NPPES UpdateJanuary 26, 20232 updates tracked since enumeration
NPPES CertifiedJanuary 26, 2023
✔ NPI 1467164145 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X
Also ListedNon-emergency Medical Transport (VAN)Taxonomy 343900000X
3636 CHERRY ROAD, Washington, NC 27889
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Other Names 1

Doing Business AsCountry Living: Hickory House

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2321900

Country Living Hickory House · Washington, NC
Active · expires Apr 10, 2027
CLIA Number34D2321900
Laboratory TypeGroup Home
Certificate Effective DateApril 11, 2025
Certificate Expiration DateApril 10, 2027
Laboratory DirectorKellie Michelle Hardison
Laboratory Phone(252) 975-3741
Laboratory LocationCountry Living Hickory House3636 Cherry Road, Washington, NC 27889
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2322059

Country Living Willow House · Washington, NC
Active · expires Apr 14, 2027
CLIA Number34D2322059
Laboratory TypeGroup Home
Certificate Effective DateApril 15, 2025
Certificate Expiration DateApril 14, 2027
Laboratory DirectorKellie Michelle Hardison
Laboratory Phone(252) 975-3741
Laboratory LocationCountry Living Willow House3644 Cherry Rd, Washington, NC 27889
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 34D2321912

Country Living Raywood House · Washington, NC
Active · expires Apr 10, 2027
CLIA Number34D2321912
Laboratory TypeGroup Home
Certificate Effective DateApril 11, 2025
Certificate Expiration DateApril 10, 2027
Laboratory DirectorKellie Michelle Hardison
Laboratory Phone(252) 975-3741
Laboratory LocationCountry Living Raywood House3706 Cherry Road, Washington, NC 27889
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Living Guest Home, Inc.'s NPI number?

The NPI number for Country Living Guest Home, Inc. is 1467164145. It was assigned to this organization in the NPPES registry on December 14, 2022. The provider is doing business as Country Living: Hickory House.

Where is Country Living Guest Home, Inc. located?

Country Living Guest Home, Inc. is located at 3636 Cherry Road, Washington, NC 27889. The listed phone number is (252) 975-3741.

What is Country Living Guest Home, Inc.'s specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Does Country Living Guest Home, Inc. hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Country Living Guest Home, Inc. was last updated on January 26, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.