Country Club Ii

LBN: Country Club Ii
Country Club Ii is an health care organization with primary practice located at 4011 Old Courthouse Rd , Sophia NC 27350-8866. The organization recently has only one registered license in Other Service Providers / Lodging, which is considered as the primary health care specialty. Country Club Ii can be contacted via phone (336) 674-6293, or through Bullock, Pearlie M. via phone (336) 674-6293.

Contact Information

Primary practice address
4011 Old Courthouse Rd Sophia NC 27350-8866
Phone: (336) 674-6293
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bullock, Pearlie M.
Phone: (336) 674-6293

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Lodging 177F00000X FCL076031 North Carolina

Profile Details

NPI number 1316087992
LBN Legal business name Country Club Ii
DBA Doing business as
Authorized official Bullock, Pearlie M.
Entity Organization
Organization subpart 1 No
Enumeration date Feb 6th, 2007
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316087992 NPPES
North Carolina MEDICAID FCL076031
North Carolina MEDICAID MLH076085

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