Country Place Village I LP

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

100561 Issued in TX

Legal business name

COUNTRY PLACE VILLAGE I LP

Practice address

2103 Chandler St
Kilgore, TX 75662-3741

Phone

(903) 984-7827

NPI assigned

Apr 6, 2007

Organization subpart

No

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

Authorized official

Name

Brian K Clarke

Title

President Ceo

Phone

(903) 566-8500

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1891817094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 479",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757100479",
            "telephone_number": "903-566-8500",
            "fax_number": "903-566-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 CHANDLER ST",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756623741",
            "telephone_number": "903-984-7827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY PLACE VILLAGE I LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "903-566-8500"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "TX",
            "license": "100561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Kilgore, TX
• Providers in Kilgore, 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 Aug 22, 2020; 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.