Country Club 2 Idd, LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

COUNTRY CLUB 2 IDD, LLC

Practice address

1339 Coltrane Mill Rd
Randleman, NC 27317-8020

Phone

(336) 312-2101

Fax

(336) 674-1692

NPI assigned

Jul 30, 2026

Last updated

Aug 19, 2026By 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

Pearlie BullockNPI 1093507667

Title

Administrator

Phone

(336) 312-2101

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pearlie Bullock

  • Developmentally Disabled Services Day Training Agency
  • Randleman, NC
  • NPI 1093507667

  Day Training, Developmentally Disabled Services

  NPD (past) Authorized official

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

{
    "created_epoch": "1785369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787097600000",
    "number": "1699698514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 COLTRANE MILL RD",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273178020",
            "telephone_number": "336-312-2101",
            "fax_number": "336-674-1692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 COLTRANE MILL RD",
            "city": "RANDLEMAN",
            "state": "NC",
            "postal_code": "273178020",
            "telephone_number": "336-312-2101",
            "fax_number": "336-674-1692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CLUB 2 IDD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-07-30",
        "last_updated": "2026-08-19",
        "certification_date": "2026-08-19",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "PEARLIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "336-312-2101"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rhonda L. Cobb, RPH
• Maci Olivia Burns Coward
• Heather Craven, PHARMD
• Janet Renee Crotty, NCLPC, NBCC
• Lindsey Jeanette Danielle Davis, PHARMD
• Deacon Med PA (Optimus Medical Center at Randleman)

• Developmentally Disabled Services Day Training Agency in Randleman, NC
• Providers in Randleman, NC by specialty
• Developmentally Disabled Services Day Training Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; 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.