Provider Demographics
NPI:1063752632
Name:COUNTRY COMFORT CARE, INC.
Entity type:Organization
Organization Name:COUNTRY COMFORT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUMARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARJUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-341-8664
Mailing Address - Street 1:15340 MALLORY LN
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8708
Mailing Address - Country:US
Mailing Address - Phone:407-469-2151
Mailing Address - Fax:
Practice Address - Street 1:15340 MALLORY LN
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34715-8708
Practice Address - Country:US
Practice Address - Phone:407-469-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12290310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility