Country Time Inn LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

COUNTRY TIME INN LLC

Practice address

602 Brevard St
Kings Mountain, NC 28086-8692

Phone

(704) 739-2760

Fax

(704) 739-6252

NPI assigned

Sep 23, 2005

Last updated

Jul 28, 2021By 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. Charles E Trefzger Jr.

Title

Manager

Phone

(828) 322-5535

Specialties & licenses 2

Addresses

Other identifiers 1

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

CLIA laboratory certificates

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1538155643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2568",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286032568",
            "telephone_number": "828-322-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 BREVARD ST",
            "city": "KINGS MOUNTAIN",
            "state": "NC",
            "postal_code": "280868692",
            "telephone_number": "704-739-2760",
            "fax_number": "704-739-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY TIME INN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "TREFZGER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "828-322-5535",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "HAL036018",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7805757",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Patterson Coleman, LMBT
• Anna Marie Colvin, LCMHC
• Community Living and Choices
• James Mitchell Costner, M.D.
• Marvin Cotten, PA
• Janie Mae Crank-Pless
• Crawley Memorial Hospital Inc
• Tyrsa Lynne Creel, PHARMD
• Brandi Nicole Crespo
• Archie Crocker

• Adult Care Home Facility in Kings Mountain, NC
• Providers in Kings Mountain, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.