Country Living Estates, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

COUNTRY LIVING ESTATES, INC

Practice address

4761 Draughon Rd
Fayetteville, NC 28312-8480

Phone

(910) 484-1701

Fax

(910) 484-1703

NPI assigned

Oct 28, 2015

Organization subpart

No

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

Authorized official

Name

Hilda Moore

Title

Administrator

Phone

(910) 484-1701

Specialties & licenses 3

Addresses

Other names 1

• Country Living Estates Assisted Living Facility Other name

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1609248855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4761 DRAUGHON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283128480",
            "telephone_number": "910-484-1701",
            "fax_number": "910-484-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4761 DRAUGHON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283128480",
            "telephone_number": "910-484-1701",
            "fax_number": "910-484-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY LIVING ESTATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "HILDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-484-1701"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": null,
            "primary": true
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "344600000X",
            "taxonomy_group": "",
            "desc": "Taxi",
            "state": "NC",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Living Estates Assisted Living Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Marianne Victoria Coton, HIS
• Deandra Cotten
• Tiffany Cottingham-Easterling
• Jonathan David Cotto-Rodriguez, PA-C
• William Bryan Cotton, PA-C
• Country Time Transit LLC
• Verbienne Roberts Counts
• County of Cumberland
• County of Cumberland
• County of Cumberland

• Assisted Living Facility in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Assisted Living Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.