Country Living Care Homes LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

039387 Issued in MO

Legal business name

COUNTRY LIVING CARE HOMES LLC

Doing business as

Country Living Assisted Living

Practice address

2820 N Main Ave
Mountain Grove, MO 65711-1403

Phone

(417) 926-1955

Fax

(417) 926-1951

NPI assigned

Jul 23, 2011

Last updated

Aug 29, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Joseph Walter Golden

Title

Owner/Management

Phone

(417) 926-1955

Specialties & licenses 1

Addresses

Other names 1

• Country Living Assisted Living Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1275811333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657110649",
            "telephone_number": "417-926-1955",
            "fax_number": "417-926-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 N MAIN AVE",
            "city": "MOUNTAIN GROVE",
            "state": "MO",
            "postal_code": "657111403",
            "telephone_number": "417-926-1955",
            "fax_number": "417-926-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY LIVING CARE HOMES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-23",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "GOLDEN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "OWNER/MANAGEMENT",
        "authorized_official_telephone_number": "417-926-1955",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "039387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Living Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Mountain Grove, MO
• Providers in Mountain Grove, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.