Country Livin' Senior Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRY LIVIN' SENIOR HOME

Practice address

4930 Sycamore Rd
Atascadero, CA 93422-4314

Phone

(805) 461-5306

Fax

(805) 464-0652

NPI assigned

Apr 11, 2008

Last updated

Apr 11, 2008By 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

Mrs. Laura Genelle Willison

Title

Owner/Administrator

Phone

(805) 461-5306

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1316110109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 SYCAMORE RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934224314",
            "telephone_number": "805-461-5306",
            "fax_number": "805-464-0652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 SYCAMORE RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934224314",
            "telephone_number": "805-461-5306",
            "fax_number": "805-464-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY LIVIN' SENIOR HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "WILLISON",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "GENELLE",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "805-461-5306",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Atascadero, CA
• Providers in Atascadero, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.