Country Pines Inc
Organization Active NPI Intellectual and/or Developmental Disabilities Residential Treatment Facility · Lagrange, NC
NPI 1588873764 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1588873764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
- License
- MHL096115 (NC)
- Legal business name
- COUNTRY PINES INC
- Practice address
- 2600 N Beston Rd
Lagrange, NC 28551-8627 - Phone
- (919) 778-1244
- NPI assigned
- May 22, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Kenneth Michael Sauls Sr., BS BUSINESS
- Title
- Vice President
- Phone
- (919) 778-4009
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Country Pines 1
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Residential Treatment Facility | 320600000X | MHL096115 | NC | Yes |
Addresses
Primary practice location
2600 N Beston Rd
Lagrange, NC 28551-8627
Mailing address
2307 N Beston Rd
Lagrange, NC 28551-8627
Phone (919) 778-4009
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7804004 | Medicaid | NC |
Other names
- Country Pines #2
Other providers in Lagrange, NC
- Ant Mary'S Family Care #1
- Goldsboro Pediatrics PA
- Tanger Lee Jones
- Nova Ic, Inc.
- Marjorie R Rachide
- With a Purpose Family Care, Inc.
All providers in Lagrange, NC · Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.