Countrywood Family Care

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

FCL-051-046 Issued in NC

Legal business name

COUNTRYWOOD FAMILY CARE

Practice address

118 Old Yogi LN
Clayton, NC 27520-6180

Phone

(919) 436-0343

NPI assigned

May 2, 2012

Organization subpart

No

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

Authorized official

Name

Mia Smith

Title

Administrator

Phone

(919) 436-0343

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1376801977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 OLD YOGI LN",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275206180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 OLD YOGI LN",
            "city": "CLAYTON",
            "state": "NC",
            "postal_code": "275206180",
            "telephone_number": "919-436-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRYWOOD FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-436-0343"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NC",
            "license": "FCL-051-046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karla Cooper, RN
• Letisha Hughes Cooper, PA-C
• Victoria R Copelton, LCSW, LCAS
• Elizabeth Mary Costine, MA, LPC, NCC
• Eric Palmer Cottle, DDS
• Shane William Courtney, PT, DPT
• Melissa Cowan Rattray
• Colleen Cox, DPT
• Denise Cox
• Craig S Carter MD Facs PA

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Clayton, NC
• Providers in Clayton, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.