COUNTRY LIVING: MAGNOLIA HOUSE – NPI #1720798804
Residential Treatment Facility, Intellectual and/or Developmental Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.

COUNTRY LIVING: MAGNOLIA HOUSE is a residential treatment facility located in WASHINGTON, NC. NPPES has assigned the NPI number 1720798804 to COUNTRY LIVING: MAGNOLIA HOUSE on November 30, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “COUNTRY LIVING: MAGNOLIA HOUSE” is a dba name, the actual legal business name for this organization is COUNTRY LIVING GUEST HOME, INC.. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 320600000X from the Health Care Provider Taxonomy code set, which is classified as Residential Treatment Facility, Intellectual and/or Developmental Disabilities.

The NPI profile was previously updated about 3 years ago on Jan 26, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for COUNTRY LIVING: MAGNOLIA HOUSE below.

NPI Profile for
COUNTRY LIVING GUEST HOME, INC.

NPI Number
1720798804
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
COUNTRY LIVING GUEST HOME, INC.
Doing Business As (dba): COUNTRY LIVING: MAGNOLIA HOUSE
Primary location
3650 CHERRY ROAD
WASHINGTON, NC 27889
Phone: (252) 975-3741 Fax: (252) 975-3044
Mailing address
217 EAST 9TH STREET
WASHINGTON, NC 27889
Phone: (252) 975-3741 Fax: (252) 975-3044
Organization Subpart
Yes - COUNTRY LIVING: MAGNOLIA HOUSE is subpart of another organization.
Authorized Official
KELLIE HARDISON
ADMINISTRATOR
Phone: (252) 975-3741
Updated
Certification Date
Jan 26, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.