| Organization Name: | COUNTRY CLUB LIVING , INC. |
| NPI Number: | 1063535854 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARMEN DELAMATA (OWNER ADMINISTRATOR) |
| Mailing Address: | 16837 N. W. 91 Ct. Miami Lakes |
| State: | FL US |
| Postal Code: | 33018 |
| Phone Number: | 3059348770 |
| Fax Number: | 3058169996 |
| NPI Enumeration Date: | 04/09/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | AL10449 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Assisted Living Facility |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |