Provider Demographics
NPI:1962527176
Name:COUNTRY LIVING SKILLED NURSING, INC.
Entity type:Organization
Organization Name:COUNTRY LIVING SKILLED NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUNNINHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-574-4239
Mailing Address - Street 1:7520 OHIO RIVER RD
Mailing Address - Street 2:PO BOX 215
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-5669
Mailing Address - Country:US
Mailing Address - Phone:740-574-4239
Mailing Address - Fax:740-574-6347
Practice Address - Street 1:7520 OHIO RIVER
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-574-4239
Practice Address - Fax:740-574-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251 E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368172Medicare Oscar/Certification