Country Home Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

121696 Issued in TX

Legal business name

COUNTRY HOME ASSISTED LIVING

Practice address

1311 Lower Seguin Rd
Marion, TX 78124-4004

Phone

(830) 420-2273

NPI assigned

Feb 13, 2008

Last updated

Feb 13, 2008By 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. Fortune A Vardeman

Title

Owner

Phone

(830) 420-2273

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1790953693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 LOWER SEGUIN RD",
            "city": "MARION",
            "state": "TX",
            "postal_code": "781244004",
            "telephone_number": "830-420-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 LOWER SEGUIN RD",
            "city": "MARION",
            "state": "TX",
            "postal_code": "781244004",
            "telephone_number": "830-420-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY HOME ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "VARDEMAN",
        "authorized_official_first_name": "FORTUNE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-420-2273",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "121696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Marion, TX
• Providers in Marion, TX by specialty
• Assisted Living Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; 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.