Provider Demographics
NPI:1598514143
Name:COUNTRY HOMES LLC
Entity type:Organization
Organization Name:COUNTRY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BINTA
Authorized Official - Middle Name:WANGUI
Authorized Official - Last Name:GATHOGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-712-0398
Mailing Address - Street 1:2619 SW 320TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2268
Mailing Address - Country:US
Mailing Address - Phone:206-712-0398
Mailing Address - Fax:253-587-9081
Practice Address - Street 1:2619 SW 320TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2268
Practice Address - Country:US
Practice Address - Phone:206-712-0398
Practice Address - Fax:253-587-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home