| Organization Name: | COUNTRY CLUB RETIREMENT CENTER LLC |
| NPI Number: | 1144372137 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANET HARRIS (CEO) |
| Mailing Address: | 925 E 26th St Ashtabula |
| State: | OH US |
| Postal Code: | 440045061 |
| Phone Number: | 4409920022 |
| Fax Number: | 4409927423 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 04/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 310400000X |
| License Number: | 4561 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| 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. |